NY State Senate Bill 2025-S7919

Current Bill Status - In Senate Committee Insurance Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

Please enter your contact information

First Name

Last Name

Email Address

A valid email address is required.

Home address is used to determine the senate district in which you reside. Your support or opposition to this bill is then shared immediately with the senator who represents you.

Optional services from the NY State Senate:

Create an account. An account allows you to officially support or oppose key legislation, sign petitions with a single click, and follow issues, committees, and bills that matter to you. When you create an account, you agree to this platform's terms of participation.

Include a custom message for your Senator? (Optional)

Enter a message to your senator. Many New Yorkers use this to share the reasoning behind their support or opposition to the bill. Others might share a personal anecdote about how the bill would affect them or people they care about.

Actions

View Actions

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
May 14, 2025	referred to insurance

2025-S7919 (ACTIVE) - Details

See Assembly Version of this Bill:: A6650
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Add §§3217-k, 4242 & 4325-a, Ins L; add §4406-j, Pub Health L

2025-S7919 (ACTIVE) - Summary

Allows dental provider networks, certain health and hospital service corporations, and health care plans to enter into a third-party network contract to provide access to care services and discounted rates of a provider under a provider network contract.

2025-S7919 (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S7919

SPONSOR: SKOUFIS
 
TITLE OF BILL:

An act to amend the insurance law and the public health law, in relation
to third-party network contracts

 
PURPOSE:

To require dental insurers to take specific measures before leasing
networks to third parties, including notifying in-network dental provid-
ers of intent to lease provider networks to a third party and securing
written consent of the provider prior to doing so.

 
SUMMARY OF PROVISIONS:

Section 1: Amends the insurance law by adding a new section 3217-k to
regulate how dental insurers may involve third parties in provider
network contracts. It permits third-party access to providers' services
and discounted rates only if the provider consents at contract initi-
ation, renewal, or upon material changes. It allows providers to opt for

direct contracts with third parties. Third parties must adhere to the
original contract's terms. Insurers cannot terminate a provider for
refusing third-party access. Insurers must disclose all third-party
access relationships, maintain an updated list online, identify discount
sources on payments, and notify providers of new third-party contracts
and terminations. Providers must consent to changes, and third-party
access ends with contract termination. The law prohibits waiving these
notice requirements in any policy issued or amended after the law's
effective date.

Section 2: Amends the insurance law by adding a new section 4242 to
permit dental insurers to grant third-party access to provider services
and rates only with the provider's consent at contract start, renewal,
or material changes. Providers must be allowed to contract directly with
third parties, and third parties must comply with all original contract
terms. Insurers must disclose third-party arrangements, maintain an
updated online list, give advance notice, and obtain provider approval
for new agreements. Third-party access ends when the provider contract
ends, and notice requirements cannot be waived in any policy issued
after the law takes effect.

Section 3: Amends the insurance law by adding a new section 4325-a to
allow corporations to enter third-party dental network contracts only
with the provider's consent at contract start, renewal, or material
changes, and mandates that third parties follow the original contract's
terms.  Providers must be allowed to contract directly with third
parties, and cannot be dropped for refusing third-party access. Corpo-
rations must disclose all third-party arrangements, maintain an updated
online list, give timely notices, and secure provider consent for new
agreements. Third party access ends when the provider contract ends, and
policies cannot waive these notice requirements after the law takes
effect.

Section 4: Amends the public health law by adding a new section 4406-j
to outline that a health care plan may enter into third-party network
contracts only if the provider consents at the time of the original
contract, renewal, or material changes, and the third party agrees to
follow all contract terms. Providers must be allowed to contract direct-
ly with third parties, and cannot be terminated for refusing third-party
access. The health care plan must provide written and electronic notice
of all third-party relationships, maintain an updated online list, iden-
tify the source of discounts on payment documents, and give timely
notice of new or ending third-party agreements. Providers must consent
to new third-party contracts, third-party access ends when the provider
contract is terminated, and no policies issued after the law's effective
date may waive these notice requirements.

Section 5: Sets effective date.

 
JUSTIFICATION:

Network leasing occurs when a dental benefits company allows a third
party-often another insurer or administrator-to access its network of
providers. This means a dentist who signed a contract with the original
dental benefits company may unknowingly be treated as "in-network" by
third parties they never agreed to work with, subjecting them to unfa-
miliar fees and policies. This lack of transparency can be especially
frustrating for dentists, who often don't learn of these third-party
affiliations until after a claim is processed. This bill seeks to
improve transparency and fairness in network leasing by requiring that
providers be notified in advance of any proposed leasing arrangements,
given the option to opt out or contract directly with the third party,
and protected from retaliation by insurers for exercising these rights.

 
LEGISLATIVE HISTORY:

New Bill.

 
FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
This act shall take effect immediately and shall apply to policies and
contracts issued, renewed, amended, modified, or altered on or after
such date.

2025-S7919 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7919
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                               May 14, 2025
                                ___________
 
 Introduced  by  Sen. SKOUFIS -- read twice and ordered printed, and when
   printed to be committed to the Committee on Insurance
 
 AN ACT to amend the insurance law and the public health law, in relation
   to third-party network contracts
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. The insurance law is amended by adding a new section 3217-k
 to read as follows:
   §  3217-K.  LEASED DENTAL NETWORKS. (A) THE FOLLOWING PROVISIONS SHALL
 APPLY TO DENTAL PROVIDER NETWORKS:
   (1) AN INSURER OF DENTAL CARE AND SERVICES MAY ENTER INTO A THIRD-PAR-
 TY 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 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
   (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) 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.
   (3) 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:
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD10275-01-5
 S. 7919                             2

 
   (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.
 S. 7919                             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.
 S. 7919                             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
 S. 7919                             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
 S. 7919                             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
 S. 7919                             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.

Comments

Open Legislation is a forum for New York State legislation. All comments are subject to review and community moderation is encouraged.

Comments deemed off-topic, commercial, campaign-related, self-promotional; or that contain profanity, hate or toxic speech; or that link to sites outside of the nysenate.gov domain are not permitted, and will not be published. Attempts to intimidate and silence contributors or deliberately deceive the public, including excessive or extraneous posting/posts, or coordinated activity, are prohibited and may result in the temporary or permanent banning of the user. Comment moderation is generally performed Monday through Friday. By contributing or voting you agree to the Terms of Participation and verify you are over 13.

Create an account. An account allows you to sign petitions with a single click, officially support or oppose key legislation, and follow issues, committees, and bills that matter to you. When you create an account, you agree to this platform's terms of participation.

Senate Bill S7919

Sponsored By

Current Bill Status - In Senate Committee Insurance Committee

2025-S7919 (ACTIVE) - Details

2025-S7919 (ACTIVE) - Summary

2025-S7919 (ACTIVE) - Sponsor Memo

2025-S7919 (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S7919

Share this bill

Sponsored By

James Skoufis

Current Bill Status - In Senate Committee Insurance Committee

2025-S7919 (ACTIVE) - Details

2025-S7919 (ACTIVE) - Summary

2025-S7919 (ACTIVE) - Sponsor Memo

2025-S7919 (ACTIVE) - Bill Text download pdf

Comments