NY State Senate Bill 2017-S948

Archive: Last Bill Status - In Senate Committee Health 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

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Actions

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 03, 2018	referred to health
Jan 05, 2017	referred to health

2017-S948 (ACTIVE) - Details

See Assembly Version of this Bill:: A5409
Current Committee:: Senate Health
Law Section:: Public Health Law
Laws Affected:: Amd §4406, Pub Health L; amd §4804, Ins L
Versions Introduced in Other Legislative Sessions:: 2009-2010: A11385
2011-2012: S2817, A3802
2013-2014: S1083, A636
2015-2016: S5374, A3527
2019-2020: S1323, A3928
2021-2022: A8909
2023-2024: A2376

2017-S948 (ACTIVE) - Summary

Relates to the reimbursement of out-of-network providers of clinical laboratory services by organizations providing or offering comprehensive health services plans.

2017-S948 (ACTIVE) - Sponsor Memo

                                 BILL NUMBER:  S948

 TITLE OF BILL :

An act to amend the public health law and the insurance law, in
relation to the reimbursement of out-of-network providers of clinical
laboratory services by organizations providing or offering
comprehensive health services plans

 PURPOSE OF BILL :

To provide that organizations providing or offering comprehensive
health service plans, such as managed care organizations and health
maintenance organizations, directly reimburse out-of-network providers
of clinical laboratory services when plan participants are referred to
out-of-network providers by in-network organizations or providers.

 SUMMARY OF SPECIFIC PROVISIONS :

Section 1. Section 4406 of the public health law by adding a new
subdivision 6. The new subdivision provides when the participant or
enrollee is referred to non-participating medical providers by
in-network medical providers, the services must be reimbursable under
the plan; requiring the out-of-network to bill the in-network
organization directly for services performed. Any payment made by the
medical provider directly to the participant rather than to the

out-of-network provider will not satisfy the organization's payment
obligation to the clinical laboratory.

Section 4804 of the insurance law is amended by adding a new
subsection (g) to with provisions that are identical to the foregoing.

 JUSTIFICATION :

In an effort to provide the best health care available, health care
organizations and providers regularly refer patients to providers
outside of such patients' organization's networks. Under current law,
however, such organizations are not required to directly reimburse
out-of-network providers for clinical laboratory services rendered.
Instead, out-of-network providers of clinical laboratory services must
look directly to the patients for payment of their fees, even though
patients are less likely to pay for the services once rendered and may
assume that the organization is required to pay for the services. This
provides a disincentive to out-of-network providers to render services
to such patients even in cases where the out of network provider may
offer better services. This practice also thwarts the medical advice
and direction of the patient's medical care giver and limits patient
healthcare options.

This legislation would expand the health care service options
available to the residents of the state and promote the referral of
patients to providers deemed to be the best for the medical care of
such patients, whether in or out-of-network

 PRIOR LEGISLATIVE HISTORY :

S.5374/A.3527 of 2015-2016; Referred to Health
S.1083/A.636 of 2013-2014; Referred to Health
S.2817/A.3802 of 2011-2012; Committee Discharged and Committed to
Rules

 FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS :

None.

 EFFECTIVE DATE :
This act shall take effect immediately

2017-S948 (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                    948
 
                        2017-2018 Regular Sessions
 
                             I N  S E N A T E
 
                              January 5, 2017
                                ___________
 
 Introduced  by  Sen.  FUNKE  -- 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 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

 S. 948                              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.

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Senate Bill S948

Sponsored By

Archive: Last Bill Status - In Senate Committee Health Committee

2017-S948 (ACTIVE) - Details

2017-S948 (ACTIVE) - Summary

2017-S948 (ACTIVE) - Sponsor Memo

2017-S948 (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S948

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Sponsored By

Rich Funke

Archive: Last Bill Status - In Senate Committee Health Committee

2017-S948 (ACTIVE) - Details

2017-S948 (ACTIVE) - Summary

2017-S948 (ACTIVE) - Sponsor Memo

2017-S948 (ACTIVE) - Bill Text download pdf

Comments