Assembly Bill A5106

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5106
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 12, 2025
                                ___________
 
 Introduced by M. of A. HUNTER -- read once and referred to the Committee
   on Insurance
 
 AN ACT to amend the insurance law and the public health law, in relation
   to prohibiting certain requirements in insurance contracts
 
   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 (p) to read as follows:
   (P)(1)  NO  INSURER THAT OFFERS A MANAGED CARE PRODUCT OR A COMPREHEN-
 SIVE POLICY THAT UTILIZES A NETWORK OF  PROVIDERS  SHALL  ENTER  INTO  A
 CONTRACT, WRITTEN POLICY, WRITTEN PROCEDURE OR AGREEMENT WITH ANY HEALTH
 CARE PROVIDER THAT:
   (A)  REQUIRES  AN  INSURER TO INCLUDE ALL MEMBERS OF A PROVIDER GROUP,
 INCLUDING MEDICAL PRACTICE GROUPS AND  FACILITIES,  IN  ITS  NETWORK  OF
 PARTICIPATING PROVIDERS;
   (B)  REQUIRES  AN  INSURER  TO  PLACE ALL MEMBERS OF A PROVIDER GROUP,
 INCLUDING MEDICAL PRACTICE GROUPS AND FACILITIES, IN  THE  SAME  NETWORK
 TIER;
   (C)  REQUIRES  AN  INSURER TO INCLUDE ALL MEMBERS OF A PROVIDER GROUP,
 INCLUDING MEDICAL  PRACTICE  GROUPS  AND  FACILITIES,  IN  ALL  PRODUCTS
 OFFERED BY THE INSURER;
   (D) PROHIBITS INSURERS FROM USING BENEFIT DESIGNS TO ENCOURAGE MEMBERS
 TO SEEK SERVICES FROM HIGHER-VALUE HEALTH CARE PROVIDERS;
   (E) CONTAINS A MOST-FAVORED-NATION PROVISION; PROVIDED, HOWEVER, NOTH-
 ING  IN THIS SECTION SHALL BE CONSTRUED TO PROHIBIT A HEALTH INSURER AND
 A PROVIDER FROM NEGOTIATING PAYMENT RATES AND PERFORMANCE-BASED CONTRACT
 TERMS THAT WOULD RESULT IN THE INSURER  RECEIVING  A  RATE  THAT  IS  AS
 FAVORABLE, OR MORE FAVORABLE, THAN THE RATES NEGOTIATED BETWEEN A HEALTH
 CARE PROVIDER AND ANOTHER ENTITY; AND

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD08595-01-5
 A. 5106                             2
 
              

   (F)  LIMITS  THE  ABILITY  OF THE INSURER OR HEALTH CARE PROVIDER FROM
 DISCLOSING FEES FOR SERVICES OR THE ALLOWED AMOUNTS  TO  AN  INSURED  OR
 INSURED'S HEALTH CARE PROVIDER.
   (2)  AFTER JANUARY FIRST, TWO THOUSAND TWENTY-SIX, ANY CONTRACT, WRIT-
 TEN POLICY, WRITTEN  PROCEDURE  OR  AGREEMENT  THAT  CONTAINS  A  CLAUSE
 CONTRARY  TO  THE PROVISIONS SET FORTH IN THIS SECTION SHALL BE NULL AND
 VOID; PROVIDED, HOWEVER, THE REMAINING CLAUSES  OF  THE  CONTRACT  SHALL
 REMAIN IN EFFECT FOR THE DURATION OF THE CONTRACT TERM.
   §  2. Section 4406 of the public health law is amended by adding a new
 subdivision 6 to read as follows:
   6. (A) NO HEALTH MAINTENANCE ORGANIZATION THAT OFFERS A  MANAGED  CARE
 PRODUCT  OR  A COMPREHENSIVE POLICY THAT UTILIZES A NETWORK OF PROVIDERS
 SHALL ENTER INTO A CONTRACT, WRITTEN POLICY, WRITTEN PROCEDURE OR AGREE-
 MENT WITH ANY HEALTH CARE PROVIDER THAT:
   (I) REQUIRES AN INSURER TO INCLUDE ALL MEMBERS OF  A  PROVIDER  GROUP,
 INCLUDING  MEDICAL  PRACTICE  GROUPS  AND  FACILITIES, IN ITS NETWORK OF
 PARTICIPATING PROVIDERS;
   (II) REQUIRES AN INSURER TO PLACE ALL MEMBERS  OF  A  PROVIDER  GROUP,
 INCLUDING  MEDICAL  PRACTICE  GROUPS AND FACILITIES, IN THE SAME NETWORK
 TIER;
   (III) REQUIRES AN INSURER TO INCLUDE ALL MEMBERS OF A PROVIDER  GROUP,
 INCLUDING  MEDICAL  PRACTICE  GROUPS  AND  FACILITIES,  IN  ALL PRODUCTS
 OFFERED BY THE INSURER;
   (IV) PROHIBITS  INSURERS  FROM  USING  BENEFIT  DESIGNS  TO  ENCOURAGE
 MEMBERS TO SEEK SERVICES FROM HIGHER-VALUE HEALTH CARE PROVIDERS;
   (V) CONTAINS A MOST-FAVORED-NATION PROVISION; PROVIDED, HOWEVER, NOTH-
 ING  IN THIS SECTION SHALL BE CONSTRUED TO PROHIBIT A HEALTH INSURER AND
 A PROVIDER FROM NEGOTIATING PAYMENT RATES AND PERFORMANCE-BASED CONTRACT
 TERMS THAT WOULD RESULT IN THE INSURER  RECEIVING  A  RATE  THAT  IS  AS
 FAVORABLE, OR MORE FAVORABLE, THAN THE RATES NEGOTIATED BETWEEN A HEALTH
 CARE PROVIDER AND ANOTHER ENTITY; AND
   (VI)  LIMITS  THE  ABILITY OF THE INSURER OR HEALTH CARE PROVIDER FROM
 DISCLOSING FEES FOR SERVICES OR THE ALLOWED AMOUNTS  TO  AN  INSURED  OR
 INSURED'S HEALTH CARE PROVIDER.
   (B)  AFTER JANUARY FIRST, TWO THOUSAND TWENTY-SIX, ANY CONTRACT, WRIT-
 TEN POLICY, WRITTEN  PROCEDURE  OR  AGREEMENT  THAT  CONTAINS  A  CLAUSE
 CONTRARY  TO  THE PROVISIONS SET FORTH IN THIS SECTION SHALL BE NULL AND
 VOID; PROVIDED, HOWEVER, THE REMAINING CLAUSES  OF  THE  CONTRACT  SHALL
 REMAIN IN EFFECT FOR THE DURATION OF THE CONTRACT TERM.
   § 3. This act shall take effect January 1, 2026.