Senate Bill S10317

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   10317
 
                             I N  S E N A T E
 
                               May 13, 2026
                                ___________
 
 Introduced  by  Sen. JACKSON -- read twice and ordered printed, and when
   printed to be committed to the Committee on Health
 
 AN ACT to amend the public health law and the insurance law, in relation
   to network participation verification and disclosure
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section 1. Legislative findings and intent. The legislature finds that
 patients  routinely  rely  on  representations  by health care providers
 regarding participation in a health plan's network. Providers frequently
 state they are "in-network" based on outdated or incomplete information,
 resulting in  unexpected  out-of-network  charges  and  financial  harm.
 Existing law requires insurers to maintain accurate provider directories
 but  imposes no corresponding duty on providers to verify their contrac-
 tual status prior to communicating with patients. This act establishes a
 clear, enforceable requirement for real-time  verification  and  disclo-
 sure,  and provides consumer protections when such verification does not
 occur.
   § 2. The public health law is amended by adding a new  section  25  to
 read as follows:
   § 25. NETWORK  PARTICIPATION  VERIFICATION  AND DISCLOSURE. 1.   DEFI-
 NITIONS. FOR PURPOSES OF THIS SECTION:
   (A) "HEALTH CARE PROVIDER" MEANS ANY INDIVIDUAL  OR  ENTITY  LICENSED,
 CERTIFIED OR AUTHORIZED TO PROVIDE HEALTH CARE SERVICES IN THIS STATE.
   (B)  "INSURER"  MEANS ANY INSURER, HEALTH MAINTENANCE ORGANIZATION, OR
 HEALTH BENEFIT PLAN SUBJECT TO THE INSURANCE LAW OR THIS CHAPTER.
   (C)  "NETWORK  PARTICIPATION  STATUS"  MEANS  WHETHER  A  PROVIDER  IS
 CONTRACTED  AS  A PARTICIPATING PROVIDER UNDER A SPECIFIC HEALTH BENEFIT
 PLAN.
   (D) "REAL-TIME VERIFICATION" MEANS AN ELECTRONIC OR TELEPHONIC CONFIR-
 MATION OBTAINED DIRECTLY FROM THE INSURER OR ITS DESIGNATED VERIFICATION
 SYSTEM WITHIN THE PRECEDING SEVENTY-TWO HOURS.
   2. VERIFICATION REQUIREMENT. NO HEALTH CARE PROVIDER, OR  EMPLOYEE  OR
 AGENT  THEREOF  SHALL REPRESENT, STATE, IMPLY OR CONFIRM TO A PATIENT OR
 PROSPECTIVE PATIENT THAT THE PROVIDER IS IN-NETWORK,  PARTICIPATING,  OR
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD15153-01-6
 S. 10317                            2
 
 OTHERWISE CONTRACTED WITH A HEALTH PLAN UNLESS REAL-TIME VERIFICATION OF
 NETWORK PARTICIPATION STATUS HAS BEEN COMPLETED.
   3.  PRE-SERVICE  DOCUMENTATION AND DISCLOSURE. (A) PRIOR TO SCHEDULING
 AN APPOINTMENT OR RENDERING ANY NON-EMERGENCY SERVICE, A PROVIDER  SHALL
 FURNISH THE PATIENT WITH WRITTEN OR ELECTRONIC DOCUMENTATION STATING:
   (I) THAT REAL-TIME VERIFICATION WAS COMPLETED; AND
   (II)  WHETHER  THE  PROVIDER  IS  IN-NETWORK OR OUT-OF-NETWORK FOR THE
 PATIENT'S SPECIFIC HEALTH PLAN.
   (B) IF THE PROVIDER IS OUT-OF-NETWORK, THE DOCUMENTATION  SHALL  STATE
 THAT  SERVICES  WILL BE BILLED AT OUT-OF-NETWORK RATES AND MAY RESULT IN
 HIGHER OUT-OF-POCKET COSTS.
   (C) DOCUMENTATION SHALL  BE  ACKNOWLEDGED  BY  THE  PATIENT  PRIOR  TO
 SERVICE.
   4.  DOCUMENTATION  RETENTION.  (A)  IF  THE  PATIENT  IS BILLED AT THE
 IN-NETWORK RATE OR LOWER, THE PROVIDER SHALL NOT BE REQUIRED  TO  RETAIN
 OR PRODUCE PROOF OF REAL-TIME VERIFICATION.
   (B)  IF  THE  PATIENT  IS BILLED AT OUT-OF-NETWORK RATES, THE PROVIDER
 SHALL RETAIN ALL VERIFICATION AND  DISCLOSURE  DOCUMENTATION  FOR  THREE
 YEARS FROM THE DATE OF SERVICE.
   (C)  PROOF  OF  REAL-TIME VERIFICATION SHALL BE REQUIRED ONLY WHEN THE
 PROVIDER BILLS OUT-OF-NETWORK.
   5. PENALTY FOR FAILURE TO DISCLOSE.  (A)  A  PROVIDER  THAT  FAILS  TO
 COMPLY WITH SUBDIVISIONS TWO OR THREE OF THIS SECTION SHALL BE PROHIBIT-
 ED  FROM  BILLING,  COLLECTING OR ATTEMPTING TO COLLECT FROM THE PATIENT
 ANY AMOUNT OTHER THAN THE  IN-NETWORK  COPAYMENT  APPLICABLE  UNDER  THE
 PATIENT'S HEALTH PLAN.
   (B)  WHERE  A CLAIM IS MADE PURSUANT TO PARAGRAPH (A) OF THIS SUBDIVI-
 SION, THE INSURER SHALL PROCESS  THE  CLAIM  AS  IF  THE  PROVIDER  WERE
 IN-NETWORK,  AND THE PROVIDER SHALL ACCEPT THE IN-NETWORK ALLOWED AMOUNT
 AS PAYMENT IN FULL.
   (C) ANY ATTEMPT TO BILL A PATIENT IN  VIOLATION  OF  THIS  SUBDIVISION
 SHALL  CONSTITUTE  A  DECEPTIVE  BUSINESS  PRACTICE  UNDER SECTION THREE
 HUNDRED FORTY-NINE OF THE GENERAL BUSINESS LAW.
   § 3. The insurance law is amended by adding a new  section  3217-k  to
 read as follows:
   § 3217-K. VERIFICATION  SYSTEMS.  1.  EVERY  INSURER  SHALL MAINTAIN A
 REAL-TIME VERIFICATION SYSTEM ACCESSIBLE TO PROVIDERS AT NO COST.
   2. INSURERS SHALL ISSUE A CONFIRMATION NUMBER OR ELECTRONIC RECORD FOR
 EACH VERIFICATION.
   3. INSURERS SHALL BE BOUND BY ANY VERIFICATION ISSUED UNLESS  OBTAINED
 THROUGH FRAUD OR MISREPRESENTATION.
   §  4.  The  insurance law is amended by adding a new section 4306-j to
 read as follows:
   § 4306-J. VERIFICATION SYSTEMS. 1. EVERY CORPORATION SHALL MAINTAIN  A
 REAL-TIME VERIFICATION SYSTEM ACCESSIBLE TO PROVIDERS AT NO COST.
   2. CORPORATIONS SHALL ISSUE A CONFIRMATION NUMBER OR ELECTRONIC RECORD
 FOR EACH VERIFICATION.
   3.  CORPORATIONS  SHALL  BE  BOUND  BY  ANY VERIFICATION ISSUED UNLESS
 OBTAINED THROUGH FRAUD OR MISREPRESENTATION.
   § 5. The public health law is amended by adding a new  section  4406-j
 to read as follows:
   § 4406-J. VERIFICATION  SYSTEMS. 1. EVERY HEALTH MAINTENANCE ORGANIZA-
 TION SHALL  MAINTAIN  A  REAL-TIME  VERIFICATION  SYSTEM  ACCESSIBLE  TO
 PROVIDERS AT NO COST.
   2.  HEALTH MAINTENANCE ORGANIZATIONS SHALL ISSUE A CONFIRMATION NUMBER
 OR ELECTRONIC RECORD FOR EACH VERIFICATION.
 S. 10317                            3
 
   3. HEALTH MAINTENANCE ORGANIZATIONS SHALL BE BOUND BY ANY VERIFICATION
 ISSUED UNLESS OBTAINED THROUGH FRAUD OR MISREPRESENTATION.
   § 6. This act shall take effect on the one hundred eightieth day after
 it  shall have become a law. Effective immediately, the addition, amend-
 ment and/or repeal of any rule or regulation necessary for the implemen-
 tation of this act on its effective date are authorized to be  made  and
 completed on or before such effective date.