Assembly Bill A6143

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   6143
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 26, 2025
                                ___________
 
 Introduced  by M. of A. SOLAGES -- read once and referred to the Commit-
   tee on Health
 
 AN ACT to amend the public health law,  in  relation  to  out-of-network
   treatment disclosure for certain surgical procedures
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section 1. Subdivision 5 of section 230-d of the public health law, as
 added by chapter 365 of the laws of 2007, is amended to read as follows:
   5. EVERY LICENSEE PERFORMING INPATIENT AND/OR OUTPATIENT SURGICAL CARE
 AND THAT REQUIRES PRE-APPROVAL OF SURGICAL PROCEDURES BY  THE  PATIENT'S
 INSURANCE  PROVIDER  SHALL  PROVIDE  NOTICE  TO  THE PATIENT IF ALL OR A
 PORTION OF TREATMENT APPROVED IS AUTHORIZED TO BE RENDERED BY A PROVIDER
 THAT IS NOT AN IN-NETWORK PROVIDER. SUCH NOTIFICATION SHALL BE  PROVIDED
 TO  THE  PATIENT BY TELEPHONE CALL, EMAIL OR TEXT MESSAGE AT THE TIME OF
 APPROVAL BY THE LICENSEE AND SHALL BE CONFIRMED BY MAIL  NOT  MORE  THAN
 TWENTY-FOUR  HOURS  AFTER  APPROVAL  OF  THE  SURGICAL PROCEDURE. IF THE
 LICENSEE FAILS TO PROVIDE SUCH NOTICE TO THE  PATIENT  AT  LEAST  FORTY-
 EIGHT HOURS PRIOR TO THE PROCEDURE, THE LICENSEE SHALL COVER THE COST OF
 THE  PROCEDURE  AS  THOUGH  THE  SERVICES WERE RENDERED BY AN IN-NETWORK
 PROVIDER. THE PROVISIONS OF THIS SUBDIVISION  SHALL  NOT  APPLY  TO  ANY
 SURGICAL  PROCEDURE PERFORMED WITHIN TWENTY-FOUR HOURS AFTER THE INSURED
 SUSTAINS THE INJURY NECESSITATING THE SURGICAL PROCEDURE.
   6. the commissioner shall make, adopt,  promulgate  and  enforce  such
 rules  and  regulations, as [he or she] THE COMMISSIONER may deem appro-
 priate, to effectuate the purposes of this section. Where  any  rule  or
 regulation  under  this  section would affect the scope of practice of a
 health care practitioner licensed, registered or certified  under  title
 eight  of the education law other than those licensed under articles one
 hundred thirty-one or one hundred thirty-one-B of the education law, the
 rule or regulation shall be made with the concurrence of the commission-
 er of education.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD10211-01-5
              

 A. 6143                             2
 
   § 2. The public health law is amended by adding a new  section  2807-g
 to read as follows:
   §  2807-G. NOTICE OF OUT-OF-NETWORK TREATMENT. EVERY HOSPITAL OR OTHER
 LICENSED ENTITY PROVIDING INPATIENT AND/OR OUTPATIENT SURGICAL CARE THAT
 REQUIRES PRE-APPROVAL OF SURGICAL PROCEDURES BY THE PATIENT'S  INSURANCE
 PROVIDER  SHALL  PROVIDE  NOTICE  TO  THE PATIENT IF ALL OR A PORTION OF
 TREATMENT APPROVED IS AUTHORIZED TO BE RENDERED BY A  PROVIDER  THAT  IS
 NOT  AN  IN-NETWORK PROVIDER. SUCH NOTIFICATION SHALL BE PROVIDED TO THE
 PATIENT BY TELEPHONE CALL, EMAIL OR TEXT MESSAGE AT THE TIME OF APPROVAL
 BY SUCH HOSPITAL OR OTHER LICENSED ENTITY AND SHALL BE CONFIRMED BY MAIL
 NOT MORE THAN TWENTY-FOUR HOURS AFTER APPROVAL OF  THE  SURGICAL  PROCE-
 DURE.  IF  SUCH  HOSPITAL OR OTHER LICENSED ENTITY FAILS TO PROVIDE SUCH
 NOTICE TO THE PATIENT AT LEAST FORTY-EIGHT HOURS PRIOR TO THE PROCEDURE,
 SUCH HOSPITAL OR OTHER LICENSED ENTITY  SHALL  COVER  THE  COST  OF  THE
 PROCEDURE  AS THOUGH THE SERVICES WERE RENDERED BY AN IN-NETWORK PROVID-
 ER. THE PROVISIONS OF THIS SUBDIVISION SHALL NOT APPLY TO  ANY  SURGICAL
 PROCEDURE  PERFORMED WITHIN TWENTY-FOUR HOURS AFTER THE INSURED SUSTAINS
 THE INJURY NECESSITATING THE SURGICAL PROCEDURE.
   § 3. This act shall take effect on the ninetieth day  after  it  shall
 have become a law.