Assembly Bill A7239

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7239
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              March 21, 2025
                                ___________
 
 Introduced  by  M.  of A. CHANDLER-WATERMAN -- read once and referred to
   the Committee on Health
 
 AN ACT to amend the social services law, in relation to requiring  Medi-
   care  and Medicaid managed care providers to provide coverage for out-
   of-network health care under certain circumstances

   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Short Title.  This act shall be known and may be cited as
 the "patient choice of health care provider protection act".
   § 2. Clause (F) of subparagraph (iii) of paragraph (a) of  subdivision
 4  of section 364-j of the social services law, as amended by section 14
 of part C of chapter 58 of the laws of 2004 and as relettered by chapter
 37 of the laws of 2010, is amended to read as follows:
   (F) A PERSON ELIGIBLE FOR OR RECEIVING MEDICAL ASSISTANCE  UNDER  THIS
 ARTICLE  WHO HAS ESTABLISHED A LONG TERM RELATIONSHIP WITH A HEALTH CARE
 PROFESSIONAL HAS REQUESTED THE MANAGED CARE PROVIDER TO APPROVE A SINGLE
 PATIENT AGREEMENT BETWEEN THE PATIENT AND THE HEALTH CARE  PROFESSIONAL,
 EVEN  IF  THE HEALTH CARE PROFESSIONAL IS NOT A RECURRING PROVIDER UNDER
 THE PERSON'S MANAGED PROVIDER  NETWORK.  THE  HEALTH  CARE  PROFESSIONAL
 SHALL  BE PAID THE MANAGED CARE PROVIDER'S IN-NETWORK RATES.  AS USED IN
 THIS CLAUSE, "LONG TERM RELATIONSHIP" MEANS A TREATMENT RELATIONSHIP  OF
 NINETY DAYS OR LONGER DURING WHICH THE HEALTH CARE PROFESSIONAL PROVIDED
 MEDICAL  ASSISTANCE TO THE PATIENT AT LEAST TEN TIMES. THE PROVISIONS OF
 THIS CLAUSE SHALL NOT APPLY IF THERE WERE ANY  REPORTED  ALLEGATIONS  OF
 FRAUD,  ABUSE  OR MALPRACTICE FROM THE HEALTH CARE PROFESSIONAL THAT THE
 MANAGED CARE PROVIDER HAS BEEN MADE AWARE OF.  SUCH  COVERAGE  SHALL  BE
 INCLUDED  AT  THE  TIME OF APPLICATION FOR MEDICAL ASSISTANCE UNDER THIS
 ARTICLE, OR, FOR COVERAGE ALREADY IN EFFECT, ON ANY ANNIVERSARY DATE  OF
 THE  COVERAGE  SUBJECT TO EVIDENCE OF ELIGIBILITY FOR MEDICAL ASSISTANCE
 UNDER THIS ARTICLE. SUCH COVERAGE MAY BE SUBJECT TO  ANNUAL  DEDUCTIBLES
 AND  CO-INSURANCE  AS  MAY  BE DEEMED APPROPRIATE BY THE COMMISSIONER OF
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD05068-01-5
              

 A. 7239                             2
 
 HEALTH AND AS ARE CONSISTENT WITH THOSE ESTABLISHED FOR  OTHER  BENEFITS
 FOR MEDICAL ASSISTANCE UNDER THIS ARTICLE; OR
   (G) other services as defined by the commissioner of health.
   §  3.  This  act shall take effect on the ninetieth day after it shall
 have become a law; provided, however, that  the  amendments  to  section
 364-j  of  the social services law made by section two of this act shall
 not affect the repeal of such section and shall be deemed repealed ther-
 ewith.