S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   3779
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 28, 2021
                                ___________
 
 Introduced  by M. of A. BYRNE -- read once and referred to the Committee
   on Health
 
 AN ACT to amend the public health law, in relation to the New York state
   of health transparency act
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section  1.  This act shall be known and may be cited as the "New York
 State of Health Transparency Act".
   § 2. Section 268-h of the public  health  law  is  renumbered  section
 268-i and a new section 268-h is added to read as follows:
   §  268-H.  MARKETPLACE  TRANSPARENCY.  THE FOLLOWING INFORMATION ABOUT
 EACH HEALTH PLAN OFFERED FOR SALE TO CONSUMERS  SHALL  BE  AVAILABLE  TO
 CONSUMERS  ON THE MARKETPLACE IN A CLEAR AND UNDERSTANDABLE FORM FOR USE
 IN COMPARING PLANS, PLAN COVERAGE, AND PLAN PREMIUMS:
   1. THE ABILITY TO DETERMINE WHETHER  SPECIFIC  TYPES  OF  HEALTH  CARE
 PRACTITIONERS  ARE  IN-NETWORK  AND  TO DETERMINE WHETHER A NAMED HEALTH
 CARE PRACTITIONER, HOSPITAL, OR OTHER PROVIDER IS IN NETWORK;
   2. ANY EXCLUSIONS FROM COVERAGE AND ANY RESTRICTIONS ON USE OR QUANTI-
 TY OF COVERED ITEMS AND SERVICES IN EACH CATEGORY OF BENEFITS;
   3. A DESCRIPTION OF HOW MEDICATIONS WILL SPECIFICALLY BE  INCLUDED  IN
 OR EXCLUDED FROM THE DEDUCTIBLE, INCLUDING A DESCRIPTION OF OUT-OF-POCK-
 ET COSTS THAT MAY NOT APPLY TO THE DEDUCTIBLE FOR A MEDICATION;
   4.  THE  SPECIFIC  DOLLAR AMOUNT OF ANY COPAY OR PERCENTAGE OF COINSU-
 RANCE FOR EACH ITEM OR SERVICE;
   5. THE ABILITY TO DETERMINE WHETHER A SPECIFIC DRUG  IS  AVAILABLE  ON
 FORMULARY,  THE  APPLICABLE COST-SHARING REQUIREMENT, WHETHER A SPECIFIC
 DRUG IS COVERED WHEN FURNISHED BY A PHYSICIAN OR CLINIC AND ANY CLINICAL
 PREREQUISITES OR AUTHORIZATION REQUIREMENTS FOR COVERAGE OF A DRUG;
   6. THE PROCESS FOR A PATIENT TO OBTAIN REVERSAL OF A HEALTH PLAN DECI-
 SION WHERE AN ITEM OR SERVICE PRESCRIBED  OR  ORDERED  BY  THE  TREATING
 PHYSICIAN HAS BEEN DENIED; AND
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD06307-01-1

 A. 3779                             2
 
   7. AN EXPLANATION OF THE AMOUNT OF COVERAGE FOR OUT-OF-NETWORK PROVID-
 ERS  OR  NON-COVERED  SERVICES, AND ANY RIGHTS OF APPEAL THAT EXIST WHEN
 OUT-OF-NETWORK PROVIDERS OR NON-COVERED SERVICES  ARE  MEDICALLY  NECES-
 SARY.
   § 3. Severability clause. If any clause, sentence, paragraph, subdivi-
 sion, or section of this act shall be adjudged by any court of competent
 jurisdiction  to  be invalid, such judgment shall not affect, impair, or
 invalidate the remainder thereof, but shall be confined in its operation
 to the clause, sentence,  paragraph,  subdivision,  or  section  thereof
 directly  involved  in the controversy in which such judgment shall have
 been rendered. It is hereby declared to be the intent of the legislature
 that this act would have been enacted even if  such  invalid  provisions
 had not been included herein.
   §  4. This act shall take effect one year after it shall have become a
 law.