S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5409
 
                        2017-2018 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 8, 2017
                                ___________
 
 Introduced  by  M. of A. WEPRIN -- Multi-Sponsored by -- M. of A. JAFFEE
   -- read once and referred to the Committee on Insurance
 
 AN ACT to amend the public health law and the insurance law, in relation
   to the reimbursement of out-of-network providers of clinical laborato-
   ry services  by  organizations  providing  or  offering  comprehensive
   health services plans
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Section 4406 of the public health law is amended by  adding
 a new subdivision 6 to read as follows:
   6.  NOTWITHSTANDING  ANY  OTHER  PROVISION  OF  LAW, IF AN ENROLLEE IS
 REFERRED BY AN IN-PLAN PROVIDER TO A  PROVIDER  OF  CLINICAL  LABORATORY
 SERVICES  NOT PARTICIPATING IN THE PLAN (A "NON-PARTICIPATING PROVIDER")
 FOR ANY SERVICE COVERED UNDER THE TERMS OF THE  PLAN,  THE  ORGANIZATION
 SHALL  BE  RESPONSIBLE  FOR  PAYMENT  DIRECTLY  TO THE NON-PARTICIPATING
 PROVIDER FOR THOSE SERVICES IN ACCORDANCE WITH THE TIME FRAME  FOR  SUCH
 PAYMENTS  SET  FORTH IN SECTION THREE THOUSAND TWO HUNDRED TWENTY-FOUR-A
 OF THE INSURANCE LAW; PROVIDED, HOWEVER,  THAT  THE  ENROLLEE  SHALL  BE
 RESPONSIBLE FOR ANY APPLICABLE COPAY, COINSURANCE OR DEDUCTIBLE FOR SUCH
 SERVICES.  CLINICAL  LABORATORIES SEEKING REIMBURSEMENT PURSUANT TO THIS
 SECTION FOR SERVICES RENDERED SHALL DIRECTLY BILL THE ORGANIZATION WHOSE
 ENROLLEE RECEIVED THE SERVICES. ANY  PAYMENT  MADE  BY  AN  ORGANIZATION
 DIRECTLY  TO THE ENROLLEE RATHER THAN TO THE CLINICAL LABORATORY SEEKING
 REIMBURSEMENT SHALL NOT SATISFY THE ORGANIZATION'S PAYMENT OBLIGATION TO
 THE CLINICAL LABORATORY.
   § 2. Section 4804 of the insurance law is  amended  by  adding  a  new
 subsection (g) to read as follows:
   (G)  NOTWITHSTANDING  ANY  OTHER  PROVISION  OF LAW, IF AN ENROLLEE IS
 REFERRED BY AN IN-PLAN PROVIDER TO A  PROVIDER  OF  CLINICAL  LABORATORY
 SERVICES  NOT PARTICIPATING IN THE PLAN (A "NON-PARTICIPATING PROVIDER")
 FOR ANY SERVICE COVERED UNDER THE TERMS OF THE  PLAN,  THE  ORGANIZATION
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD04265-01-7

 A. 5409                             2
 
 SHALL  BE  RESPONSIBLE  FOR  PAYMENT  DIRECTLY  TO THE NON-PARTICIPATING
 PROVIDER FOR THOSE SERVICES IN ACCORDANCE WITH THE TIME FRAME  FOR  SUCH
 PAYMENTS  SET  FORTH IN SECTION THREE THOUSAND TWO HUNDRED TWENTY-FOUR-A
 OF THIS CHAPTER; PROVIDED, HOWEVER, THAT THE ENROLLEE SHALL BE RESPONSI-
 BLE  FOR  ANY  APPLICABLE  COPAY,  COINSURANCE  OR  DEDUCTIBLE  FOR SUCH
 SERVICES. CLINICAL LABORATORIES SEEKING REIMBURSEMENT PURSUANT  TO  THIS
 SECTION FOR SERVICES RENDERED SHALL DIRECTLY BILL THE ORGANIZATION WHOSE
 ENROLLEE  RECEIVED  THE  SERVICES.  ANY  PAYMENT MADE BY AN ORGANIZATION
 DIRECTLY TO THE ENROLLEE RATHER THAN TO THE CLINICAL LABORATORY  SEEKING
 REIMBURSEMENT SHALL NOT SATISFY THE ORGANIZATION'S PAYMENT OBLIGATION TO
 THE CLINICAL LABORATORY.
   § 3. This act shall take effect immediately.