S T A T E O F N E W Y O R K
________________________________________________________________________
2205
2023-2024 Regular Sessions
I N A S S E M B L Y
January 24, 2023
___________
Introduced by M. of A. CRUZ -- read once and referred to the Committee
on Insurance
AN ACT to amend the insurance law and the public health law, in relation
to certain health care contracts or agreements; and to amend a chapter
of the laws of 2022 amending the insurance law relating to certain
prohibited contract provisions, as proposed in legislative bills
numbers S. 7199-A and A. 8169-A, in relation to the effectiveness
thereof
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Section 4235 of the insurance law is amended by adding a
new subsection (o) to read as follows:
(O) (1) NO CONTRACT OR AGREEMENT BETWEEN A HEALTH PLAN SUBJECT TO THIS
ARTICLE AND A HEALTH CARE PROVIDER, OTHER THAN A RESIDENTIAL HEALTH CARE
FACILITY AS DEFINED BY SECTION TWENTY-EIGHT HUNDRED ONE OF THE PUBLIC
HEALTH LAW, SHALL INCLUDE A PROVISION THAT:
(A) CONTAINS A MOST-FAVORED-NATION PROVISION; OR
(B) RESTRICTS THE ABILITY OF A CORPORATION, AN ENTITY THAT CONTRACTS
WITH A CORPORATION FOR A PROVIDER NETWORK, OR A HEALTH CARE PROVIDER TO
DISCLOSE: (I) ACTUAL CLAIMS COSTS; OR (II) PRICE OR QUALITY INFORMATION
REQUIRED TO BE DISCLOSED UNDER FEDERAL LAW, INCLUDING THE ALLOWED
AMOUNT, NEGOTIATED RATES OR DISCOUNTS, OR ANY OTHER CLAIM-RELATED FINAN-
CIAL OBLIGATIONS, INCLUDING, BUT NOT LIMITED TO, PATIENT COST-SHARING
COVERED BY THE PROVIDER CONTRACT TO ANY SUBSCRIBER, ENROLLEE, GROUP, OR
OTHER ENTITY RECEIVING HEALTH CARE SERVICES PURSUANT TO THE CONTRACT, OR
TO ANY PUBLIC COMPILATION OF REIMBURSEMENT DATA SUCH AS THE NEW YORK ALL
PAYER DATABASE REQUIRED BY LAW OR REGULATION, PROVIDED THAT NO DISCLO-
SURE SHALL INCLUDE PROTECTED HEALTH INFORMATION OR OTHER INFORMATION
COVERED BY STATUTORY OR OTHER PRIVILEGE.
(2) FOR PURPOSES OF THIS SUBSECTION, THE TERM "HEALTH PLAN" SHALL
INCLUDE: (A) AN INSURER LICENSED PURSUANT TO THIS CHAPTER OR A HEALTH
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD04298-01-3
A. 2205 2
MAINTENANCE ORGANIZATION CERTIFIED PURSUANT TO ARTICLE FORTY-FOUR OF THE
PUBLIC HEALTH LAW; AND
(B) A THIRD-PARTY ADMINISTRATOR, AFFILIATED WITH AN INSURER OR HEALTH
MAINTENANCE ORGANIZATION, WHO ADMINISTERS A HEALTH BENEFIT PLAN.
§ 2. Section 4406-c of the public health law is amended by adding a
new subdivision 13 to read as follows:
13. (A) NO CONTRACT OR AGREEMENT BETWEEN A HEALTH PLAN SUBJECT TO THIS
ARTICLE AND A HEALTH CARE PROVIDER, OTHER THAN A RESIDENTIAL HEALTH CARE
FACILITY AS DEFINED BY SECTION TWENTY-EIGHT HUNDRED ONE OF THIS CHAPTER,
SHALL INCLUDE A PROVISION THAT:
(I) CONTAINS A MOST-FAVORED-NATION PROVISION; OR
(II) RESTRICTS THE ABILITY OF A HEALTH PLAN, AN ENTITY THAT CONTRACTS
WITH A HEALTH CARE PLAN FOR A PROVIDER NETWORK, OR A HEALTH CARE PROVID-
ER TO DISCLOSE: (A) ACTUAL CLAIMS COSTS; OR (B) PRICE OR QUALITY INFOR-
MATION REQUIRED TO BE DISCLOSED UNDER FEDERAL LAW, INCLUDING THE ALLOWED
AMOUNT, NEGOTIATED RATES OR DISCOUNTS, OR ANY OTHER CLAIM-RELATED FINAN-
CIAL OBLIGATIONS, INCLUDING, BUT NOT LIMITED TO, PATIENT COST-SHARING
COVERED BY THE PROVIDER CONTRACT TO ANY SUBSCRIBER, ENROLLEE, GROUP, OR
OTHER ENTITY RECEIVING HEALTH CARE SERVICES PURSUANT TO THE CONTRACT, OR
TO ANY PUBLIC COMPILATION OF REIMBURSEMENT DATA SUCH AS THE NEW YORK ALL
PAYER DATABASE REQUIRED BY LAW OR REGULATION, PROVIDED THAT NO DISCLO-
SURE SHALL INCLUDE PROTECTED HEALTH INFORMATION OR OTHER INFORMATION
COVERED BY STATUTORY OR OTHER PRIVILEGE.
(B) FOR PURPOSES OF THIS SUBDIVISION, THE TERM "HEALTH PLAN" SHALL
INCLUDE:
(I) AN INSURER LICENSED PURSUANT TO THE INSURANCE LAW OR A HEALTH
MAINTENANCE ORGANIZATION CERTIFIED PURSUANT TO THIS ARTICLE; AND
(II) A THIRD-PARTY ADMINISTRATOR, AFFILIATED WITH AN INSURER OR HEALTH
MAINTENANCE ORGANIZATION, WHO ADMINISTERS A HEALTH BENEFIT PLAN.
§ 3. Section 2 of a chapter of the laws of 2022 amending the insurance
law relating to certain prohibited contract provisions, as proposed in
legislative bills numbers S. 7199-A and A. 8169-A, is amended to read as
follows:
§ 2. This act shall take effect [January] JULY 1, 2023.
§ 4. This act shall take effect immediately, provided, however, that
sections one and two of this act shall take effect on the same date and
in the same manner as a chapter of the laws of 2022 amending the insur-
ance law relating to certain prohibited contract provisions, as proposed
in legislative bills numbers S. 7199-A and A. 8169-A, takes effect.