BILL NUMBER: S2189

SPONSOR: BAILEY
 
TITLE OF BILL:

An act to amend the public health law, in relation to expanding health
care plan contract coverage for any health care provider for one hundred
twenty days after the termination of such contract

 
PURPOSE OR GENERAL IDEA OF BILL:

The purpose of this bill, in instances where a contract between a health
plan and a provider is not renewed, is to extend the period of time from
two months to 120 days where a consumer with such health plan may
utilize the services of such provider under the terms of the former
contract. The bill would also provide that coverage during the 120 day
period would extend to all health care entities that are part of the
provider's organization (included in the former contract), not just
hospitals as is currently law.

 
SUMMARY OF SPECIFIC PROVISIONS:

              

Section one amends subdivision 5-d of section 4406-c of the public
health law to provide that health plan consumers shall be able to visit
any health care provider under the terms of the former contract, when
such contract is not renewed, for a period of 120 days. Existing law
provides that consumers are only permitted to visit hospitals under the
terms of the former contract for a period of 60 days.

Section two is the effective date.

 
JUSTIFICATION:

When a massive health insurance company and a health care provider
organization cannot come to an agreement on rates, New Yorkers who
happen to have such insurance should be given ample time to plan for the
change in their health care access. This is especially true in areas
where one provider dominates a region's health care market.  Such was
nearly the case in the Bronx where Unitedhealthcare (UHC) and Montefiore
failed to renew their contract for over seven months, placing thousands
in jeopardy of losing access to their primary care doctors and health
care services provided by Montefiore. Ultimately the two entities came
to a resolution but it highlighted the need to reexamine existing law on
this issue.

Public health law provides for a "cooling off" period of two months
where individuals are still able to visit a provider hospital under the
terms of the former contract. The UHC/Montefiore dispute,' which
occurred over the course of 2021, demonstrated first, that two months is
simply not enough time given the vital nature of health care coverage,
and second, that only authorizing hospital visits under the former
contract, and not all provider entities (such as primary care doctors),
is insufficient.

Thankfully there is a baseline in public health law for extending cover-
age during such instances, and this bill would build on that foundation
to provide more health care security to New Yorkers.

 
PRIOR LEGISLATIVE HISTORY:
2021-22: S7758 - Referred to Health

 
FISCAL IMPLICATIONS:

Undetermined.

 
EFFECTIVE DATE:
This act shall take effect immediately; provided, however that the
amendments to subdivision 5-d of section 4406-c of the public health law
made by section one of this act shall not affect the repeal of such
subdivision and shall be deemed repealed therewith.