Senate Bill S1544

2023-2024 Legislative Session

Requires Medicare and Medicaid managed care providers to provide coverage for certain out-of-network health care

download bill text pdf

Sponsored By

Current Bill Status - In Senate Committee Health Committee


  • Introduced
    • In Committee Assembly
    • In Committee Senate
    • On Floor Calendar Assembly
    • On Floor Calendar Senate
    • Passed Assembly
    • Passed Senate
  • Delivered to Governor
  • Signed By Governor

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2023-S1544 (ACTIVE) - Details

See Assembly Version of this Bill:
A6465
Current Committee:
Senate Health
Law Section:
Social Services Law
Laws Affected:
Amd §364-j, Soc Serv L
Versions Introduced in Other Legislative Sessions:
2019-2020: S8856, A8606
2021-2022: S3735, A2342

2023-S1544 (ACTIVE) - Summary

Requires Medicare and Medicaid managed care providers to provide coverage for certain out-of-network health care when the patient has a long term relationship with a medical professional who is not a recurring provider under the managed care provider's network.

2023-S1544 (ACTIVE) - Sponsor Memo

2023-S1544 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1544
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                             January 12, 2023
                                ___________
 
 Introduced  by  Sen.  COMRIE -- read twice and ordered printed, and when
   printed to be committed to the Committee on Health
 
 AN ACT to amend the social services law, in relation to requiring  Medi-
   care  and Medicaid managed care providers to provide coverage for out-
   of-network health care under certain circumstances

   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Short Title.  This act shall be known and may be cited as
 the "patient choice of health care provider protection act".
   § 2. Clause (F) of subparagraph (iii) of paragraph (a) of  subdivision
 4  of section 364-j of the social services law, as amended by section 14
 of part C of chapter 58 of the laws of 2004 and as relettered by chapter
 37 of the laws of 2010, is amended to read as follows:
   (F) A PERSON ELIGIBLE FOR OR RECEIVING MEDICAL ASSISTANCE  UNDER  THIS
 ARTICLE  WHO HAS ESTABLISHED A LONG TERM RELATIONSHIP WITH A HEALTH CARE
 PROFESSIONAL HAS REQUESTED THE MANAGED CARE PROVIDER TO APPROVE A SINGLE
 PATIENT AGREEMENT BETWEEN THE PATIENT AND THE HEALTH CARE  PROFESSIONAL,
 EVEN  IF  THE HEALTH CARE PROFESSIONAL IS NOT A RECURRING PROVIDER UNDER
 THE PERSON'S MANAGED PROVIDER  NETWORK.  THE  HEALTH  CARE  PROFESSIONAL
 SHALL  BE PAID THE MANAGED CARE PROVIDER'S IN-NETWORK RATES.  AS USED IN
 THIS CLAUSE, "LONG TERM RELATIONSHIP" MEANS A TREATMENT RELATIONSHIP  OF
 NINETY DAYS OR LONGER DURING WHICH THE HEALTH CARE PROFESSIONAL PROVIDED
 MEDICAL  ASSISTANCE TO THE PATIENT AT LEAST TEN TIMES. THE PROVISIONS OF
 THIS CLAUSE SHALL NOT APPLY IF THERE WERE ANY  REPORTED  ALLEGATIONS  OF
 FRAUD,  ABUSE  OR MALPRACTICE FROM THE HEALTH CARE PROFESSIONAL THAT THE
 MANAGED CARE PROVIDER HAS BEEN MADE AWARE OF.  SUCH  COVERAGE  SHALL  BE
 INCLUDED  AT  THE  TIME OF APPLICATION FOR MEDICAL ASSISTANCE UNDER THIS
 ARTICLE, OR, FOR COVERAGE ALREADY IN EFFECT, ON ANY ANNIVERSARY DATE  OF
 THE  COVERAGE  SUBJECT TO EVIDENCE OF ELIGIBILITY FOR MEDICAL ASSISTANCE
 UNDER THIS ARTICLE. SUCH COVERAGE MAY BE SUBJECT TO  ANNUAL  DEDUCTIBLES
 AND  CO-INSURANCE  AS  MAY  BE DEEMED APPROPRIATE BY THE COMMISSIONER OF
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD03557-01-3
              

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