Assembly Bill A256

2017-2018 Legislative Session

Provides for a right of health maintenance organization enrollees to continue to receive services from a provider who disaffiliates

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Archive: Last Bill Status - On Floor Calendar


  • 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

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2017-A256 (ACTIVE) - Details

Law Section:
Insurance Law
Laws Affected:
Amd §§4803 & 4804, Ins L; amd §§4403 & 4406-d, Pub Health L
Versions Introduced in Other Legislative Sessions:
2009-2010: A633
2011-2012: A1808
2013-2014: A366
2015-2016: A1932
2019-2020: A5033
2021-2022: A2299
2023-2024: A5129

2017-A256 (ACTIVE) - Summary

Extends period during which health maintenance organization enrollees may continue to receive services from a health care provider who disaffiliates from 60 or 90 days to 1 year, or in case of terminal illness, until the time of such insured's death; bars incentives which induce a provider to provide health care to an enrollee in a manner inconsistent with law.

2017-A256 (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                    256
 
                        2017-2018 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              January 5, 2017
                                ___________
 
 Introduced by M. of A. DINOWITZ, GOTTFRIED, GALEF, HOOPER -- Multi-Spon-
   sored  by -- M.  of A. COLTON, LIFTON -- read once and referred to the
   Committee on Health
 
 AN ACT to amend the insurance law and the public health law, in relation
   to access to health care providers in managed care plans

   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Subsection  (e)  of section 4803 of the insurance law, as
 added by chapter 705 of the laws of 1996, is amended to read as follows:
   (e) No insurer shall terminate or  refuse  to  renew  a  contract  for
 participation in the in-network benefits portion of an insurer's network
 for  a  managed care product solely because the health care professional
 has: (1) advocated on behalf of an insured; (2) [has] filed a  complaint
 against  the  insurer; (3) [has] appealed a decision of the insurer; (4)
 provided information or filed a report pursuant  to  section  forty-four
 hundred  six-c of the public health law; [or] (5) requested a hearing or
 review pursuant to this section; OR (6) RENDERED  AN  OPINION  REGARDING
 WHETHER  AN INSURED'S ILLNESS IS TERMINAL PURSUANT TO SECTION FOUR THOU-
 SAND EIGHT HUNDRED FOUR OF THIS ARTICLE.
   § 2. Subsections (e) and (f) of section 4804 of the insurance law,  as
 added  by  chapter  705  of  the  laws  of  1996, are amended to read as
 follows:
   (e) (1) If an insured's health  care  provider  leaves  the  insurer's
 in-network  benefits  portion  of its network of providers for a managed
 care product for reasons other than those for which the  provider  would
 not  be  eligible  to  receive  a  hearing  pursuant to paragraph one of
 subsection (b) of section  [forty-eight]  FOUR  THOUSAND  EIGHT  hundred
 three of this [chapter] ARTICLE, the insurer shall permit the insured to
 continue  [an  ongoing  course of treatment with] TO RECEIVE HEALTH CARE
 PROCEDURES, TREATMENTS, AND SERVICES FROM the insured's  current  health
 care  provider  during  a transitional period of (i) up to [ninety days]
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

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