(A) AT THE TIME A PROVIDER NETWORK CONTRACT IS ENTERED INTO, RENEWED
OR EXTENDED, GIVE TO THE PROVIDER, IN WRITING AND ELECTRONICALLY, A LIST
OF ALL THIRD PARTIES KNOWN BY THE INSURER TO WHICH THE INSURER HAS OR
WILL PROVIDE ACCESS TO THE SERVICES AND DISCOUNTED RATES OF THE PROVIDER
UNDER THE PROVIDER NETWORK CONTRACT;
(B) MAINTAIN A WEBSITE THROUGH WHICH THE PROVIDER MAY OBTAIN A LIST,
UPDATED AT LEAST EVERY NINETY DAYS, OF ALL THIRD PARTIES THAT HAVE
ACCESS TO THE PROVIDER'S CARE SERVICES AND DISCOUNTED RATES UNDER THE
PROVIDER NETWORK CONTRACT;
(C) REQUIRE A THIRD PARTY TO IDENTIFY ON EACH REMITTANCE OR EXPLANA-
TION OF PAYMENT SENT TO A PROVIDER THE SOURCE OF ANY CONTRACTUAL
DISCOUNT IN RATES TAKEN BY THE THIRD PARTY UNDER THE PROVIDER NETWORK
CONTRACT;
(D) NOTIFY THE PROVIDER NO LESS THAN THIRTY DAYS PRIOR TO THE EFFEC-
TIVE DATE OF A NEW THIRD-PARTY NETWORK CONTRACT;
(E) NOTIFY EACH THIRD PARTY DESCRIBED UNDER SUBPARAGRAPHS (A) AND (B)
OF THIS PARAGRAPH OF THE TERMINATION OF THE PROVIDER NETWORK CONTRACT NO
LATER THAN NINETY DAYS PRIOR TO THE EFFECTIVE DATE OF SUCH TERMINATION;
(F) MAKE AVAILABLE TO A PROVIDER WITHIN THIRTY DAYS OF THE PROVIDER'S
REQUEST A COPY OF THE PROVIDER NETWORK CONTRACT CURRENTLY IN FORCE THAT
WAS RELIED UPON BY THE INSURER IN THE ADJUDICATION OF THE PROVIDER'S
CLAIM; AND
(G) SECURE THE CONSENT OF THE PROVIDER TO ANY CHANGES OR NEW THIRD
PARTY AGREEMENT WITHIN THIRTY DAYS OF NOTIFICATION PURSUANT TO SUBPARA-
GRAPH (D) OF THIS PARAGRAPH.
(B) THE NOTICE REQUIRED UNDER SUBPARAGRAPHS (D) AND (E) OF PARAGRAPH
THREE OF SUBSECTION (A) OF THIS SECTION SHALL BE PROVIDED BY ANY REASON-
ABLE MEANS, INCLUDING BUT NOT LIMITED TO WRITTEN NOTICE, ELECTRONIC
COMMUNICATION OR AN UPDATE TO AN ELECTRONIC DATABASE.
(C) SUBJECT TO ANY APPLICABLE CONTINUITY OF CARE REQUIREMENTS, AGREE-
MENTS OR CONTRACTUAL PROVISIONS, A THIRD PARTY'S RIGHT TO ACCESS A
PROVIDER'S SERVICES AND DISCOUNTED RATES UNDER A PROVIDER NETWORK
CONTRACT SHALL TERMINATE ON THE DATE THE PROVIDER NETWORK CONTRACT IS
TERMINATED.
(D) NO POLICY OR CONTRACT ISSUED, RENEWED, MODIFIED, ALTERED OR
AMENDED AFTER THE EFFECTIVE DATE OF THIS SECTION SHALL CONTAIN
PROVISIONS ALLOWING FOR WAIVER OF THE NOTICE REQUIREMENTS CONTAINED IN
THIS SECTION.
(E) FOR PURPOSES OF THIS SECTION, THE FOLLOWING TERMS SHALL HAVE THE
FOLLOWING MEANINGS:
(1) "PROVIDER" SHALL MEAN A DENTIST OR GROUP OF DENTISTS LICENSED
PURSUANT TO ARTICLE ONE HUNDRED THIRTY-THREE OF THE EDUCATION LAW.
(2) "CONSENT" SHALL MEAN A WRITTEN CONSENT SIGNED BY THE PROVIDER.
(3) "MATERIAL MODIFICATION" SHALL MEAN CHANGES TO THE TERMS OR CONDI-
TIONS OF A CONTRACT THAT ALTER REIMBURSEMENT RATES PAID TO PROVIDERS,
FEE SCHEDULES FOR PROVIDERS, OR BENEFITS OR COVERED PROCEDURES UNDER A
PLAN FOR WHICH A PROVIDER IS A NETWORK PROVIDER BUT SHALL NOT INCLUDE
ADDING A NEW THIRD PARTY TO AN EXISTING THIRD-PARTY NETWORK CONTRACT
WITHOUT ANY MATERIAL MODIFICATION TO THE THIRD-PARTY NETWORK CONTRACT.
(4) "PROVIDER NETWORK CONTRACT" SHALL MEAN A CONTRACT ENTERED INTO
BETWEEN A PROVIDER AND INSURER OF DENTAL CARE AND SERVICES FOR THE
PROVISION OF SERVICES TO ENROLLEES IN PLANS OFFERED BY THE INSURER.
(5) "THIRD PARTY" SHALL MEAN AN ENTITY, INCLUDING BUT NOT LIMITED TO A
PAYER, DENTAL BENEFITS ADMINISTRATOR OR A DENTAL NETWORK LEASING COMPA-
NY, THAT ENTERS INTO A THIRD-PARTY NETWORK CONTRACT WITH AN INSURER OF
DENTAL CARE AND SERVICES.
A. 6650 3
(6) "THIRD-PARTY NETWORK CONTRACT" SHALL MEAN A CONTRACT ENTERED INTO
BETWEEN AN INSURER AND A THIRD PARTY INSURER OF DENTAL CARE AND SERVICES
TO GAIN ACCESS TO SERVICES AND DISCOUNTED RATES OF A PROVIDER UNDER THE
ORIGINAL PROVIDER NETWORK CONTRACT WITH THE PROVIDER.
§ 2. The insurance law is amended by adding a new section 4242 to read
as follows:
§ 4242. NETWORK LEASING. (A) AN INSURER OF DENTAL CARE AND SERVICES
MAY ENTER INTO A THIRD-PARTY NETWORK CONTRACT TO PROVIDE ACCESS TO CARE
SERVICES AND DISCOUNTED RATES OF A PROVIDER UNDER A PROVIDER NETWORK
CONTRACT IF:
(1) THE PROVIDER IN THE NETWORK CONSENTS TO ALLOW THE THIRD PARTY TO
ACCESS THE PROVIDER'S SERVICES AND DISCOUNTED RATES AT THE TIME THE
ORIGINAL CONTRACT IS ENTERED INTO OR RENEWED AND WHENEVER THERE IS A
MATERIAL MODIFICATION TO THE THIRD-PARTY NETWORK CONTRACT;
(2) THE INSURER ALLOWS THE PROVIDER TO CONTRACT DIRECTLY WITH THE
THIRD PARTY INSTEAD OF ALLOWING THE THIRD PARTY TO ACCESS THE PROVIDER'S
SERVICES AND DISCOUNTED RATES; AND
(3) THE THIRD-PARTY NETWORK CONTRACT OBLIGATES THE THIRD PARTY TO
COMPLY WITH ALL APPLICABLE TERMS, LIMITATIONS AND CONDITIONS OF THE
PROVIDER NETWORK CONTRACT.
(B) AN INSURER OF DENTAL CARE AND SERVICES MAY NOT CANCEL OR OTHERWISE
TERMINATE A NETWORK PROVIDER CONTRACT WITH A PROVIDER ON THE GROUNDS
THAT THE PROVIDER REFUSES TO ALLOW ACCESS BY A THIRD PARTY TO THE
PROVIDER'S SERVICES AND DISCOUNTED RATES.
(C) AN INSURER OF DENTAL CARE AND SERVICES THAT CONTRACTS WITH A THIRD
PARTY TO PROVIDE ACCESS TO THE SERVICES AND DISCOUNTED RATES OF A
PROVIDER UNDER A PROVIDER NETWORK CONTRACT SHALL:
(1) AT THE TIME A PROVIDER NETWORK CONTRACT IS ENTERED INTO, RENEWED
OR EXTENDED, GIVE TO THE PROVIDER, IN WRITING AND ELECTRONICALLY, A LIST
OF ALL THIRD PARTIES KNOWN BY THE INSURER TO WHICH THE INSURER HAS OR
WILL PROVIDE ACCESS TO THE SERVICES AND DISCOUNTED RATES OF THE PROVIDER
UNDER THE PROVIDER NETWORK CONTRACT;
(2) MAINTAIN A WEBSITE THROUGH WHICH THE PROVIDER MAY OBTAIN A LIST,
UPDATED AT LEAST EVERY NINETY DAYS, OF ALL THIRD PARTIES THAT HAVE
ACCESS TO THE PROVIDER'S CARE SERVICES AND DISCOUNTED RATES UNDER THE
PROVIDER NETWORK CONTRACT;
(3) REQUIRE A THIRD PARTY TO IDENTIFY ON EACH REMITTANCE OR EXPLANA-
TION OF PAYMENT SENT TO A PROVIDER THE SOURCE OF ANY CONTRACTUAL
DISCOUNT IN RATES TAKEN BY THE THIRD PARTY UNDER THE PROVIDER NETWORK
CONTRACT;
(4) NOTIFY THE PROVIDER NO LESS THAN THIRTY DAYS PRIOR TO THE EFFEC-
TIVE DATE OF A NEW THIRD-PARTY NETWORK CONTRACT;
(5) NOTIFY EACH THIRD PARTY DESCRIBED UNDER PARAGRAPHS ONE AND TWO OF
THIS SUBSECTION OF THE TERMINATION OF THE PROVIDER NETWORK CONTRACT NO
LATER THAN NINETY DAYS PRIOR TO THE EFFECTIVE DATE OF SUCH TERMINATION;
(6) MAKE AVAILABLE TO A PROVIDER WITHIN THIRTY DAYS OF THE PROVIDER'S
REQUEST A COPY OF THE PROVIDER NETWORK CONTRACT CURRENTLY IN FORCE THAT
WAS RELIED UPON BY THE INSURER IN THE ADJUDICATION OF THE PROVIDER'S
CLAIM; AND
(7) SECURE THE CONSENT OF THE PROVIDER TO ANY CHANGES OR NEW THIRD
PARTY AGREEMENT WITHIN THIRTY DAYS OF NOTIFICATION PURSUANT TO PARAGRAPH
FOUR OF THIS SUBSECTION.
(D) THE NOTICE REQUIRED UNDER PARAGRAPHS FOUR AND FIVE OF SUBSECTION
(C) OF THIS SECTION SHALL BE PROVIDED BY ANY REASONABLE MEANS, INCLUDING
BUT NOT LIMITED TO WRITTEN NOTICE, ELECTRONIC COMMUNICATION OR AN UPDATE
TO AN ELECTRONIC DATABASE.
A. 6650 4
(E) SUBJECT TO ANY APPLICABLE CONTINUITY OF CARE REQUIREMENTS, AGREE-
MENTS OR CONTRACTUAL PROVISIONS, A THIRD PARTY'S RIGHT TO ACCESS A
PROVIDER'S SERVICES AND DISCOUNTED RATES UNDER A PROVIDER NETWORK
CONTRACT SHALL TERMINATE ON THE DATE THE PROVIDER NETWORK CONTRACT IS
TERMINATED.
(F) NO POLICY OR CONTRACT ISSUED, RENEWED, MODIFIED, ALTERED OR
AMENDED AFTER THE EFFECTIVE DATE OF THIS SECTION SHALL CONTAIN
PROVISIONS ALLOWING FOR WAIVER OF THE NOTICE REQUIREMENTS CONTAINED IN
THIS SECTION.
(G) FOR PURPOSES OF THIS SECTION, THE FOLLOWING TERMS SHALL HAVE THE
FOLLOWING MEANINGS:
(1) "PROVIDER" SHALL MEAN A DENTIST OR GROUP OF DENTISTS LICENSED
PURSUANT TO ARTICLE ONE HUNDRED THIRTY-THREE OF THE EDUCATION LAW.
(2) "CONSENT" SHALL MEAN A WRITTEN CONSENT SIGNED BY THE PROVIDER.
(3) "MATERIAL MODIFICATION" SHALL MEAN CHANGES TO THE TERMS OR CONDI-
TIONS OF A CONTRACT THAT ALTER REIMBURSEMENT RATES PAID TO PROVIDERS,
FEE SCHEDULES FOR PROVIDERS, OR BENEFITS OR COVERED PROCEDURES UNDER A
PLAN FOR WHICH A PROVIDER IS A NETWORK PROVIDER BUT SHALL NOT INCLUDE
ADDING A NEW THIRD PARTY TO AN EXISTING THIRD-PARTY NETWORK CONTRACT
WITHOUT ANY MATERIAL MODIFICATION TO THE THIRD-PARTY NETWORK CONTRACT.
(4) "PROVIDER NETWORK CONTRACT" SHALL MEAN A CONTRACT ENTERED INTO
BETWEEN A PROVIDER AND INSURER OF DENTAL CARE AND SERVICES FOR THE
PROVISION OF SERVICES TO ENROLLEES IN PLANS OFFERED BY THE INSURER.
(5) "THIRD PARTY" SHALL MEAN AN ENTITY, INCLUDING BUT NOT LIMITED TO A
PAYER, DENTAL BENEFITS ADMINISTRATOR OR A DENTAL NETWORK LEASING COMPA-
NY, THAT ENTERS INTO A THIRD-PARTY NETWORK CONTRACT WITH AN INSURER OF
DENTAL CARE AND SERVICES.
(6) "THIRD-PARTY NETWORK CONTRACT" SHALL MEAN A CONTRACT ENTERED INTO
BETWEEN AN INSURER AND A THIRD PARTY INSURER OF DENTAL CARE AND SERVICES
TO GAIN ACCESS TO SERVICES AND DISCOUNTED RATES OF A PROVIDER UNDER THE
ORIGINAL PROVIDER NETWORK CONTRACT WITH THE PROVIDER.
§ 3. The insurance law is amended by adding a new section 4325-a to
read as follows:
§ 4325-A. LEASED NETWORKS. (A) A CORPORATION ORGANIZED UNDER THIS
TITLE:
(1) MAY ENTER INTO A THIRD-PARTY NETWORK CONTRACT TO PROVIDE ACCESS TO
CARE SERVICES AND DISCOUNTED RATES OF A PROVIDER UNDER A PROVIDER
NETWORK CONTRACT IF:
(A) THE PROVIDER IN THE NETWORK CONSENTS TO ALLOW THE THIRD PARTY TO
ACCESS THE PROVIDER'S SERVICES AND DISCOUNTED RATES AT THE TIME THE
ORIGINAL CONTRACT IS ENTERED INTO OR RENEWED AND WHENEVER THERE IS A
MATERIAL MODIFICATION TO THE THIRD-PARTY NETWORK CONTRACT;
(B) THE CORPORATION ALLOWS THE PROVIDER TO CONTRACT DIRECTLY WITH THE
THIRD PARTY INSTEAD OF ALLOWING THE THIRD PARTY TO ACCESS THE PROVIDER'S
SERVICES AND DISCOUNTED RATES; AND
(C) THE THIRD-PARTY NETWORK CONTRACT OBLIGATES THE THIRD PARTY TO
COMPLY WITH ALL APPLICABLE TERMS, LIMITATIONS AND CONDITIONS OF THE
PROVIDER NETWORK CONTRACT;
(2) MAY NOT CANCEL OR OTHERWISE TERMINATE A NETWORK PROVIDER CONTRACT
WITH A PROVIDER ON THE GROUNDS THAT THE PROVIDER REFUSES TO ALLOW ACCESS
BY A THIRD PARTY TO THE PROVIDER'S SERVICES AND DISCOUNTED RATES;
(3) WHERE THE CORPORATION CONTRACTS WITH A THIRD PARTY TO PROVIDE
ACCESS TO THE SERVICES AND DISCOUNTED RATES OF A PROVIDER UNDER A
PROVIDER NETWORK CONTRACT, SHALL:
(A) AT THE TIME A PROVIDER NETWORK CONTRACT IS ENTERED INTO, RENEWED
OR EXTENDED, GIVE TO THE PROVIDER, IN WRITING AND ELECTRONICALLY, A LIST
A. 6650 5
OF ALL THIRD PARTIES KNOWN BY THE CORPORATION TO WHICH THE INSURER HAS
OR WILL PROVIDE ACCESS TO THE SERVICES AND DISCOUNTED RATES OF THE
PROVIDER UNDER THE PROVIDER NETWORK CONTRACT;
(B) MAINTAIN A WEBSITE THROUGH WHICH THE PROVIDER MAY OBTAIN A LIST,
UPDATED AT LEAST EVERY NINETY DAYS, OF ALL THIRD PARTIES THAT HAVE
ACCESS TO THE PROVIDER'S CARE SERVICES AND DISCOUNTED RATES UNDER THE
PROVIDER NETWORK CONTRACT;
(C) REQUIRE A THIRD PARTY TO IDENTIFY ON EACH REMITTANCE OR EXPLANA-
TION OF PAYMENT SENT TO A PROVIDER THE SOURCE OF ANY CONTRACTUAL
DISCOUNT IN RATES TAKEN BY THE THIRD PARTY UNDER THE PROVIDER NETWORK
CONTRACT;
(D) NOTIFY THE PROVIDER NO LESS THAN THIRTY DAYS PRIOR TO THE EFFEC-
TIVE DATE OF A NEW THIRD-PARTY NETWORK CONTRACT;
(E) NOTIFY EACH THIRD PARTY DESCRIBED UNDER SUBPARAGRAPHS (A) AND (B)
OF THIS PARAGRAPH OF THE TERMINATION OF THE PROVIDER NETWORK CONTRACT NO
LATER THAN NINETY DAYS PRIOR TO THE EFFECTIVE DATE OF SUCH TERMINATION;
(F) MAKE AVAILABLE TO A PROVIDER WITHIN THIRTY DAYS OF THE PROVIDER'S
REQUEST A COPY OF THE PROVIDER NETWORK CONTRACT CURRENTLY IN FORCE THAT
WAS RELIED UPON BY THE CORPORATION IN THE ADJUDICATION OF THE PROVIDER'S
CLAIM; AND
(G) SECURE THE CONSENT OF THE PROVIDER TO ANY CHANGES OR NEW THIRD-
PARTY AGREEMENT WITHIN THIRTY DAYS OF NOTIFICATION PURSUANT TO SUBPARA-
GRAPH (D) OF THIS PARAGRAPH;
(4) PROVIDE THE NOTICE REQUIRED UNDER SUBPARAGRAPHS (D) AND (E) OF
PARAGRAPH THREE OF THIS SUBSECTION BY ANY REASONABLE MEANS, INCLUDING
BUT NOT LIMITED TO WRITTEN NOTICE, ELECTRONIC COMMUNICATION OR AN UPDATE
TO AN ELECTRONIC DATABASE;
(5) SUBJECT TO ANY APPLICABLE CONTINUITY OF CARE REQUIREMENTS, AGREE-
MENTS OR CONTRACTUAL PROVISIONS, SHALL ENSURE A THIRD PARTY'S RIGHT TO
ACCESS A PROVIDER'S SERVICES AND DISCOUNTED RATES UNDER A PROVIDER
NETWORK CONTRACT WILL TERMINATE ON THE DATE THE PROVIDER NETWORK
CONTRACT IS TERMINATED; AND
(6) SHALL NOT ISSUE, RENEW, MODIFY, ALTER OR AMEND ANY POLICY OR
CONTRACT AFTER THE EFFECTIVE DATE OF THIS SECTION TO CONTAIN PROVISIONS
ALLOWING FOR WAIVER OF THE NOTICE REQUIREMENTS CONTAINED IN THIS
SECTION.
(B) FOR PURPOSES OF THIS SECTION, THE FOLLOWING TERMS SHALL HAVE THE
FOLLOWING MEANINGS:
(1) "PROVIDER" SHALL MEAN A DENTIST OR GROUP OF DENTISTS LICENSED
PURSUANT TO ARTICLE ONE HUNDRED THIRTY-THREE OF THE EDUCATION LAW.
(2) "CONSENT" SHALL MEAN A WRITTEN CONSENT SIGNED BY THE PROVIDER.
(3) "MATERIAL MODIFICATION" SHALL MEAN CHANGES TO THE TERMS OR CONDI-
TIONS OF A CONTRACT THAT ALTER REIMBURSEMENT RATES PAID TO PROVIDERS,
FEE SCHEDULES FOR PROVIDERS, OR BENEFITS OR COVERED PROCEDURES UNDER A
PLAN FOR WHICH A PROVIDER IS A NETWORK PROVIDER BUT SHALL NOT INCLUDE
ADDING A NEW THIRD PARTY TO AN EXISTING THIRD-PARTY NETWORK CONTRACT
WITHOUT ANY MATERIAL MODIFICATION TO THE THIRD-PARTY NETWORK CONTRACT.
(4) "PROVIDER NETWORK CONTRACT" SHALL MEAN A CONTRACT ENTERED INTO
BETWEEN A PROVIDER AND INSURER OF DENTAL CARE AND SERVICES FOR THE
PROVISION OF SERVICES TO ENROLLEES IN PLANS OFFERED BY THE INSURER.
(5) "THIRD PARTY" SHALL MEAN AN ENTITY, INCLUDING BUT NOT LIMITED TO A
PAYER, DENTAL BENEFITS ADMINISTRATOR OR A DENTAL NETWORK LEASING COMPA-
NY, THAT ENTERS INTO A THIRD-PARTY NETWORK CONTRACT WITH AN INSURER OF
DENTAL CARE AND SERVICES.
(6) "THIRD-PARTY NETWORK CONTRACT" SHALL MEAN A CONTRACT ENTERED INTO
BETWEEN AN INSURER AND A THIRD PARTY INSURER OF DENTAL CARE AND SERVICES
A. 6650 6
TO GAIN ACCESS TO SERVICES AND DISCOUNTED RATES OF A PROVIDER UNDER THE
ORIGINAL PROVIDER NETWORK CONTRACT WITH THE PROVIDER.
§ 4. The public health law is amended by adding a new section 4406-j
to read as follows:
§ 4406-J. LEASED NETWORKS. 1. A HEALTH CARE PLAN:
(A) MAY ENTER INTO A THIRD-PARTY NETWORK CONTRACT TO PROVIDE ACCESS TO
CARE SERVICES AND DISCOUNTED RATES OF A PROVIDER UNDER A PROVIDER
NETWORK CONTRACT IF:
(I) THE PROVIDER IN THE NETWORK CONSENTS TO ALLOW THE THIRD PARTY TO
ACCESS THE PROVIDER'S SERVICES AND DISCOUNTED RATES AT THE TIME THE
ORIGINAL CONTRACT IS ENTERED INTO OR RENEWED AND WHENEVER THERE IS A
MATERIAL MODIFICATION TO THE THIRD-PARTY NETWORK CONTRACT;
(II) THE HEALTH CARE PLAN ALLOWS THE PROVIDER TO CONTRACT DIRECTLY
WITH THE THIRD PARTY INSTEAD OF ALLOWING THE THIRD PARTY TO ACCESS THE
PROVIDER'S SERVICES AND DISCOUNTED RATES; AND
(III) THE THIRD-PARTY NETWORK CONTRACT OBLIGATES THE THIRD PARTY TO
COMPLY WITH ALL APPLICABLE TERMS, LIMITATIONS AND CONDITIONS OF THE
PROVIDER NETWORK CONTRACT;
(B) MAY NOT CANCEL OR OTHERWISE TERMINATE A NETWORK PROVIDER CONTRACT
WITH A PROVIDER ON THE GROUNDS THAT THE PROVIDER REFUSES TO ALLOW ACCESS
BY A THIRD PARTY TO THE PROVIDER'S SERVICES AND DISCOUNTED RATES;
(C) WHERE THE HEALTH CARE PLAN CONTRACTS WITH A THIRD PARTY TO PROVIDE
ACCESS TO THE SERVICES AND DISCOUNTED RATES OF A PROVIDER UNDER A
PROVIDER NETWORK CONTRACT, SHALL:
(I) AT THE TIME A PROVIDER NETWORK CONTRACT IS ENTERED INTO, RENEWED
OR EXTENDED, GIVE TO THE PROVIDER, IN WRITING AND ELECTRONICALLY, A LIST
OF ALL THIRD PARTIES KNOWN BY THE HEALTH CARE PLAN TO WHICH THE INSURER
HAS OR WILL PROVIDE ACCESS TO THE SERVICES AND DISCOUNTED RATES OF THE
PROVIDER UNDER THE PROVIDER NETWORK CONTRACT;
(II) MAINTAIN A WEBSITE THROUGH WHICH THE PROVIDER MAY OBTAIN A LIST,
UPDATED AT LEAST EVERY NINETY DAYS, OF ALL THIRD PARTIES THAT HAVE
ACCESS TO THE PROVIDER'S CARE SERVICES AND DISCOUNTED RATES UNDER THE
PROVIDER NETWORK CONTRACT;
(III) REQUIRE A THIRD PARTY TO IDENTIFY ON EACH REMITTANCE OR EXPLANA-
TION OF PAYMENT SENT TO A PROVIDER THE SOURCE OF ANY CONTRACTUAL
DISCOUNT IN RATES TAKEN BY THE THIRD PARTY UNDER THE PROVIDER NETWORK
CONTRACT;
(IV) NOTIFY THE PROVIDER NO LESS THAN THIRTY DAYS PRIOR TO THE EFFEC-
TIVE DATE OF A NEW THIRD-PARTY NETWORK CONTRACT;
(V) NOTIFY EACH THIRD PARTY DESCRIBED UNDER SUBPARAGRAPHS (I) AND (II)
OF THIS PARAGRAPH OF THE TERMINATION OF THE PROVIDER NETWORK CONTRACT NO
LATER THAN NINETY DAYS PRIOR TO THE EFFECTIVE DATE OF SUCH TERMINATION;
(VI) MAKE AVAILABLE TO A PROVIDER WITHIN THIRTY DAYS OF THE PROVIDER'S
REQUEST A COPY OF THE PROVIDER NETWORK CONTRACT CURRENTLY IN FORCE THAT
WAS RELIED UPON BY THE HEALTH CARE PLAN IN THE ADJUDICATION OF THE
PROVIDER'S CLAIM; AND
(VII) SECURE THE CONSENT OF THE PROVIDER TO ANY CHANGES OR NEW THIRD
PARTY AGREEMENT WITHIN THIRTY DAYS OF NOTIFICATION PURSUANT TO SUBPARA-
GRAPH (IV) OF THIS PARAGRAPH;
(D) SHALL PROVIDE THE NOTICE REQUIRED UNDER SUBPARAGRAPHS (IV) AND (V)
OF PARAGRAPH (C) OF THIS SUBDIVISION BY ANY REASONABLE MEANS, INCLUDING
BUT NOT LIMITED TO WRITTEN NOTICE, ELECTRONIC COMMUNICATION OR AN UPDATE
TO AN ELECTRONIC DATABASE;
(E) SUBJECT TO ANY APPLICABLE CONTINUITY OF CARE REQUIREMENTS, AGREE-
MENTS OR CONTRACTUAL PROVISIONS, SHALL ENSURE THAT A THIRD PARTY'S RIGHT
TO ACCESS A PROVIDER'S SERVICES AND DISCOUNTED RATES UNDER A PROVIDER
A. 6650 7
NETWORK CONTRACT WILL TERMINATE ON THE DATE THE PROVIDER NETWORK
CONTRACT IS TERMINATED; AND
(F) SHALL NOT ISSUE, RENEW, MODIFY, ALTER OR AMEND ANY POLICY OR
CONTRACT AFTER THE EFFECTIVE DATE OF THIS SECTION TO CONTAIN PROVISIONS
ALLOWING FOR WAIVER OF THE NOTICE REQUIREMENTS CONTAINED IN THIS
SECTION.
2. FOR PURPOSES OF THIS SECTION, THE FOLLOWING TERMS SHALL HAVE THE
FOLLOWING MEANINGS:
(A) "PROVIDER" SHALL MEAN A DENTIST OR GROUP OF DENTISTS LICENSED
PURSUANT TO ARTICLE ONE HUNDRED THIRTY-THREE OF THE EDUCATION LAW.
(B) "CONSENT" SHALL MEAN A WRITTEN CONSENT SIGNED BY THE PROVIDER.
(C) "MATERIAL MODIFICATION" SHALL MEAN CHANGES TO THE TERMS OR CONDI-
TIONS OF A CONTRACT THAT ALTER REIMBURSEMENT RATES PAID TO PROVIDERS,
FEE SCHEDULES FOR PROVIDERS, OR BENEFITS OR COVERED PROCEDURES UNDER A
PLAN FOR WHICH A PROVIDER IS A NETWORK PROVIDER BUT SHALL NOT INCLUDE
ADDING A NEW THIRD PARTY TO AN EXISTING THIRD-PARTY NETWORK CONTRACT
WITHOUT ANY MATERIAL MODIFICATION TO THE THIRD-PARTY NETWORK CONTRACT.
(D) "PROVIDER NETWORK CONTRACT" SHALL MEAN A CONTRACT ENTERED INTO
BETWEEN A PROVIDER AND INSURER OF DENTAL CARE AND SERVICES FOR THE
PROVISION OF SERVICES TO ENROLLEES IN PLANS OFFERED BY THE INSURER.
(E) "THIRD PARTY" SHALL MEAN AN ENTITY, INCLUDING BUT NOT LIMITED TO A
PAYER, DENTAL BENEFITS ADMINISTRATOR OR A DENTAL NETWORK LEASING COMPA-
NY, THAT ENTERS INTO A THIRD-PARTY NETWORK CONTRACT WITH AN INSURER OF
DENTAL CARE AND SERVICES.
(F) "THIRD-PARTY NETWORK CONTRACT" SHALL MEAN A CONTRACT ENTERED INTO
BETWEEN AN INSURER AND A THIRD PARTY INSURER OF DENTAL CARE AND SERVICES
TO GAIN ACCESS TO SERVICES AND DISCOUNTED RATES OF A PROVIDER UNDER THE
ORIGINAL PROVIDER NETWORK CONTRACT WITH THE PROVIDER.
(G) "HEALTH CARE PLAN" SHALL MEAN A HEALTH MAINTENANCE ORGANIZATION
LICENSED PURSUANT TO ARTICLE FORTY-THREE OF THE INSURANCE LAW OR CERTI-
FIED PURSUANT TO THIS ARTICLE OR AN INDEPENDENT PRACTICE ASSOCIATION
CERTIFIED OR RECOGNIZED PURSUANT TO THIS ARTICLE OR A MEDICAL GROUP.
§ 5. This act shall take effect immediately and shall apply to poli-
cies and contracts issued, renewed, amended, modified or altered on or
after such date.