Provides that no insurer, health maintenance organization, or any other entity shall, by contract, written policy, or procedure, reduce the payment of a negotiated rate for evaluation and management or procedural services furnished by a participating provider that are otherwise covered services, solely because the provider also billed other health care services.
S T A T E O F N E W Y O R K
________________________________________________________________________
11688
I N A S S E M B L Y
September 2, 2026
___________
Introduced by COMMITTEE ON RULES -- (at request of M. of A. Weprin) --
read once and referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to reducing inequities in
access to medical procedures
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Section 3217-b of the insurance law is amended by adding a
new subsection (q) to read as follows:
(Q) (1) NO INSURER, HEALTH MAINTENANCE ORGANIZATION, OR ANY OTHER
ENTITY SUBJECT TO THIS ARTICLE SHALL, BY CONTRACT, WRITTEN POLICY, OR
PROCEDURE, REDUCE THE PAYMENT OF A NEGOTIATED RATE FOR EVALUATION AND
MANAGEMENT OR PROCEDURAL SERVICES FURNISHED BY A PARTICIPATING PROVIDER
THAT ARE OTHERWISE COVERED SERVICES, SOLELY BECAUSE THE PROVIDER ALSO
BILLED OTHER HEALTH CARE SERVICES, INCLUDING BUT NOT LIMITED TO MINOR
PROCEDURES, ON THE SAME DAY AS THE EVALUATION AND MANAGEMENT OR PROCE-
DURAL SERVICES.
(2) ANY PROVISION OF A PARTICIPATING PROVIDER AGREEMENT THAT ALLOWS
FOR A REDUCTION IN REIMBURSEMENT AS PROHIBITED BY THIS SUBSECTION SHALL
BE VOID AND UNENFORCEABLE.
(3) WITH RESPECT TO AN INSURED ENROLLED IN A HEALTH BENEFIT PLAN UNDER
WHICH THE INSURER OR UTILIZATION REVIEW ORGANIZATION ONLY PROVIDES
ADMINISTRATIVE SERVICES, THE OBLIGATIONS CREATED BY THIS SUBSECTION
SHALL BE LIMITED TO RECOMMENDING TO THE THIRD-PARTY PAYOR THAT COVERAGE
AND PAYMENT SHOULD BE AUTHORIZED IN ACCORDANCE WITH THE PROHIBITIONS SET
FORTH HEREIN.
§ 2. This act shall take effect immediately and shall apply to all
contracts and policies issued, renewed, modified, or amended on or after
such effective date.
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD16240-01-6
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