Senate Bill S10512

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   10512
 
                             I N  S E N A T E
 
                               May 15, 2026
                                ___________
 
 Introduced  by  Sen.  RIVERA -- read twice and ordered printed, and when
   printed to be committed to the Committee on Insurance
 
 AN ACT to amend the insurance law, in relation to  payments  to  medical
   services providers
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section 1. Section 3224-a of the insurance law is amended by adding  a
 new subsection (m) to read as follows:
   (M)  PAYMENTS  TO  NONPARTICIPATING OR NONPREFERRED PROVIDERS LICENSED
 UNDER THE PUBLIC HEALTH LAW OR THE EDUCATION LAW. (1) WHENEVER AN INSUR-
 ER OR AN ORGANIZATION, OR CORPORATION LICENSED OR CERTIFIED PURSUANT  TO
 ARTICLE FORTY-THREE OR FORTY-SEVEN OF THIS CHAPTER OR ARTICLE FORTY-FOUR
 OF  THE PUBLIC HEALTH LAW PROVIDES THAT ANY HEALTH CARE CLAIMS SUBMITTED
 UNDER CONTRACTS OR AGREEMENTS ISSUED OR ENTERED INTO  PURSUANT  TO  THIS
 ARTICLE OR ARTICLE FORTY-TWO, FORTY-THREE OR FORTY-SEVEN OF THIS CHAPTER
 AND ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW ARE PAYABLE TO A PARTIC-
 IPATING OR PREFERRED PROVIDER FOR SERVICES RENDERED, THE INSURER, ORGAN-
 IZATION,  OR  CORPORATION  LICENSED  OR  CERTIFIED  PURSUANT  TO ARTICLE
 FORTY-THREE OR FORTY-SEVEN OF THIS CHAPTER OR ARTICLE FORTY-FOUR OF  THE
 PUBLIC HEALTH LAW SHALL BE REQUIRED TO PAY SUCH BENEFITS EITHER DIRECTLY
 TO  ANY  SIMILARLY LICENSED NONPARTICIPATING OR NONPREFERRED PROVIDER AT
 THE USUAL AND CUSTOMARY CHARGE, WHICH SHALL NOT BE EXCESSIVE  OR  UNREA-
 SONABLE,  WHEN  THE  PROVIDER  HAS RENDERED SUCH SERVICES, HAS ON FILE A
 DULY EXECUTED ASSIGNMENT OF BENEFITS, AND  HAS  CAUSED  NOTICE  OF  SUCH
 ASSIGNMENT  TO  BE  GIVEN  TO  THE INSURER, ORGANIZATION, OR CORPORATION
 LICENSED OR CERTIFIED PURSUANT TO ARTICLE FORTY-THREE OR FORTY-SEVEN  OF
 THIS  CHAPTER  OR ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW OR JOINTLY
 TO SUCH NONPARTICIPATING OR NONPREFERRED PROVIDER AND  TO  THE  INSURED,
 SUBSCRIBER,  OR  OTHER COVERED PERSON; PROVIDED, HOWEVER, THAT IN EITHER
 CASE THE INSURER, ORGANIZATION, OR  CORPORATION  LICENSED  OR  CERTIFIED
 PURSUANT  TO ARTICLE FORTY-THREE OR FORTY-SEVEN OF THIS CHAPTER OR ARTI-
 CLE FORTY-FOUR OF THE PUBLIC HEALTH LAW SHALL BE REQUIRED TO  SEND  SUCH
 BENEFIT  PAYMENTS  DIRECTLY  TO  THE  PROVIDER WHO HAS THE ASSIGNMENT ON
 FILE. WHEN PAYMENT IS MADE DIRECTLY TO A PROVIDER AS AUTHORIZED BY  THIS
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD13775-02-6
 S. 10512                            2
 
 SECTION, THE INSURER, ORGANIZATION, OR CORPORATION LICENSED OR CERTIFIED
 PURSUANT  TO ARTICLE FORTY-THREE OR FORTY-SEVEN OF THIS CHAPTER OR ARTI-
 CLE FORTY-FOUR OF THE PUBLIC HEALTH LAW SHALL  GIVE  WRITTEN  NOTICE  OF
 SUCH PAYMENT TO THE INSURED, SUBSCRIBER, OR OTHER COVERED PERSON.
   (2)   AN  INSURER  SHALL  PROVIDE  REIMBURSEMENT  FOR  THOSE  SERVICES
 PRESCRIBED BY THIS SECTION AT RATES NEGOTIATED BETWEEN THE  INSURER  AND
 THE  PROVIDER  OF SUCH SERVICES. IN THE ABSENCE OF AGREED UPON RATES, AN
 INSURER SHALL PAY FOR SUCH SERVICES AT THE USUAL AND  CUSTOMARY  CHARGE,
 WHICH SHALL NOT BE EXCESSIVE OR UNREASONABLE.
   (3) A NONPARTICIPATING OR NONPREFERRED PROVIDER SHALL NOT SEEK ADVANCE
 PAYMENT, DEPOSITS, OR FULL PAYMENT FOR COVERED SERVICES FROM AN INSURED,
 SUBSCRIBER,  OR  OTHER  COVERED PERSON UNLESS AND UNTIL THE PROVIDER HAS
 FIRST SUBMITTED A CLAIM TO THE APPLICABLE INSURER AND THE CLAIM HAS BEEN
 ADJUDICATED. NOTHING CONTAINED  IN  THIS  SECTION  SHALL  BE  DEEMED  TO
 PROHIBIT  THE  PAYMENT  OF  DIFFERENT  LEVELS OF BENEFITS OR FROM HAVING
 DIFFERENCES IN COINSURANCE PERCENTAGES APPLICABLE TO BENEFIT LEVELS  FOR
 SERVICES PROVIDED BY PARTICIPATING OR PREFERRED PROVIDERS AND NONPARTIC-
 IPATING OR NONPREFERRED PROVIDERS.
   §  2.  This  act  shall take effect January 1, 2027 and shall apply to
 health care claims submitted for payment after such date.