S T A T E O F N E W Y O R K
________________________________________________________________________
5069
2023-2024 Regular Sessions
I N A S S E M B L Y
March 2, 2023
___________
Introduced by M. of A. GUNTHER -- read once and referred to the Commit-
tee on Insurance
AN ACT to amend the insurance law and the public health law, in relation
to the processing of health claims
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Paragraph 2 of subsection (a) of section 3224-b of the
insurance law, as added by chapter 551 of the laws of 2006, is amended
to read as follows:
(2) Subject to the provisions of paragraph three of this subsection, a
health plan shall accept and initiate the processing of all health care
claims submitted by a physician, INCLUDING BUT NOT LIMITED TO EVALUATION
AND MANAGEMENT CODES, pursuant to and consistent with the current
version of the American medical association's current procedural termi-
nology (CPT) codes, reporting guidelines and conventions and the centers
for medicare and medicaid services healthcare common procedure coding
system (HCPCS).
§ 2. Paragraphs 4 and 5 of subsection (b) of section 3224-b of the
insurance law, as amended by chapter 237 of the laws of 2009, are renum-
bered paragraphs 5 and 6 and a new paragraph 4 is added to read as
follows:
(4) NOTWITHSTANDING PARAGRAPH THREE OF THIS SUBSECTION, WITH RESPECT
TO CLAIMS FOR EVALUATION AND MANAGEMENT CODES AS SUCH ARE DEFINED AND
SET FORTH IN THE CURRENT EDITION OF AMERICAN MEDICAL ASSOCIATION'S
CURRENT PROCEDURAL TERMINOLOGY (CPT), A HEALTH PLAN SHALL FOLLOW, COMPLY
WITH AND IMPLEMENT FOR PURPOSES OF CLAIMS PROCESSING, CLAIMS PAYMENT AND
CLAIMS REVIEW, SUCH CURRENT PROCEDURAL TERMINOLOGY PROVISIONS, GUIDE-
LINES AND CONVENTIONS FOR BOTH THE SELECTION AND THE DOCUMENTATION OF
EVALUATION AND MANAGEMENT SERVICES.
§ 3. Section 4406-c of the public health law is amended by adding two
new subdivisions 13 and 14 to read as follows:
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD09869-01-3
A. 5069 2
13. A HEALTH MAINTENANCE ORGANIZATION LICENSED PURSUANT TO ARTICLE
FORTY-THREE OF THE INSURANCE LAW OR CERTIFIED PURSUANT TO THIS ARTICLE
OR AN INDEPENDENT PRACTICE ASSOCIATION CERTIFIED OR RECOGNIZED PURSUANT
TO THIS ARTICLE OR A MEDICAL GROUP SHALL NOT PROHIBIT THE ACCEPTANCE,
INITIATION AND PROCESSING OF ALL HEALTH CARE CLAIMS SUBMITTED BY A
PHYSICIAN, INCLUDING BUT NOT LIMITED TO EVALUATION AND MANAGEMENT CODES,
PURSUANT TO AND CONSISTENT WITH THE CURRENT VERSION OF THE AMERICAN
MEDICAL ASSOCIATION'S CURRENT PROCEDURAL TERMINOLOGY (CPT), REPORTING
GUIDELINES AND CONVENTIONS AND THE CENTERS FOR MEDICARE AND MEDICAID
SERVICES HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS).
14. NOTWITHSTANDING PROVISIONS OF THIS SECTION OR SUBSECTION (B) OF
SECTION THREE THOUSAND TWO HUNDRED TWENTY-FOUR OF THE INSURANCE LAW,
WITH RESPECT TO CLAIMS FOR EVALUATION AND MANAGEMENT CODES AS SUCH ARE
DEFINED AND SET FORTH IN THE CURRENT EDITION OF AMERICAN MEDICAL ASSOCI-
ATION'S CURRENT PROCEDURAL TERMINOLOGY (CPT), A HEALTH PLAN SHALL
FOLLOW, COMPLY WITH AND IMPLEMENT FOR PURPOSES OF CLAIMS PROCESSING,
CLAIMS PAYMENT AND CLAIMS REVIEW, SUCH CURRENT PROCEDURAL TERMINOLOGY
PROVISIONS, GUIDELINES, AND CONVENTIONS FOR BOTH THE SELECTION OF AND
THE DOCUMENTATION OF EVALUATION AND MANAGEMENT SERVICES.
§ 4. The commissioner of health and the superintendent of the depart-
ment of financial services shall promulgate rules and regulations and
take any other actions reasonably necessary to implement the provisions
of this act.
§ 5. This act shall take effect immediately.