S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   8169
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                               July 7, 2021
                                ___________
 
 Introduced  by  M. of A. CRUZ -- read once and referred to the Committee
   on Insurance
 
 AN ACT to amend the insurance law and the public health law, in relation
   to certain prohibited contract provisions
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section  1. Section 3217-b of the insurance law is amended by adding a
 new subsection (m) to read as follows:
   (M) (1) NO INSURER THAT OFFERS A MANAGED CARE PRODUCT OR A  COMPREHEN-
 SIVE  POLICY  THAT  UTILIZES  A  NETWORK OF PROVIDERS SHALL ENTER INTO A
 CONTRACT, WRITTEN POLICY, WRITTEN PROCEDURE  OR  AGREEMENT  (HEREINAFTER
 AND SOLELY FOR PURPOSES OF THIS SUBSECTION COLLECTIVELY REFERRED TO AS A
 "CONTRACT") WITH ANY HEALTH CARE PROVIDER THAT:
   (A)  REQUIRES  THE INSURER TO INCLUDE WITHIN THE SCOPE OF THE CONTRACT
 ALL COVERED GROUPS OF THE INSURER, INCLUDING  GROUPS  OR  BENEFIT  FUNDS
 THAT  CONTRACT  WITH  THE  INSURER,  OR AN AFFILIATE OF THE INSURER, FOR
 ACCESS TO THE INSURER'S NETWORK OF PARTICIPATING PROVIDERS;
   (B) REQUIRES AN INSURER TO INCLUDE ALL MEMBERS OF A  PROVIDER  SYSTEM,
 INCLUDING  MEDICAL  PRACTICE  GROUPS  AND  AFFILIATED FACILITIES, IN ITS
 NETWORK OF PARTICIPATING PROVIDERS;
   (C) REQUIRES AN INSURER, OR AN AFFILIATE OF AN INSURER, TO INCLUDE ALL
 MEMBERS OF A PROVIDER SYSTEM,  INCLUDING  MEDICAL  PRACTICE  GROUPS  AND
 AFFILIATED  FACILITIES,  IN  ALL  PRODUCTS  OFFERED BY THE INSURER OR AN
 AFFILIATE OF THE INSURER;
   (D) RESTRICTS THE ABILITY OF AN INSURER TO CREATE OR MODIFY  A  TIERED
 NETWORK  BENEFIT  PLAN  OR REQUIRES AN INSURER TO PLACE ALL MEMBERS OF A
 PROVIDER SYSTEM, INCLUDING MEDICAL PRACTICE GROUPS AND AFFILIATED FACIL-
 ITIES, IN THE SAME NETWORK TIER OR OTHERWISE  LIMITS  THE  RIGHT  OF  AN
 INSURER TO PLACE A PROVIDER IN A PARTICULAR TIER;
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD11774-01-1

              

 A. 8169                             2
 
   (E)  PROHIBITS INSURERS FROM USING BENEFIT DESIGNS, INCLUDING WELLNESS
 PROGRAMS AND OTHER BENEFITS, TO ENCOURAGE MEMBERS TO SEEK SERVICES  FROM
 VALUE-BASED HEALTH CARE PROVIDERS;
   (F) CONTAINS A MOST-FAVORED-NATION PROVISION; PROVIDED, HOWEVER, NOTH-
 ING  IN THIS SECTION SHALL BE CONSTRUED TO PROHIBIT A HEALTH INSURER AND
 A PROVIDER FROM NEGOTIATING PAYMENT RATES AND PERFORMANCE-BASED CONTRACT
 TERMS THAT WOULD RESULT IN THE INSURER  RECEIVING  A  RATE  THAT  IS  AS
 FAVORABLE, OR MORE FAVORABLE, THAN THE RATES NEGOTIATED BETWEEN A HEALTH
 CARE PROVIDER AND ANOTHER ENTITY; OR
   (G)  RESTRICTS THE ABILITY OF THE INSURER TO DISCLOSE PRICE OR QUALITY
 INFORMATION,  INCLUDING  THE  ALLOWED  AMOUNT,   NEGOTIATED   RATES   OR
 DISCOUNTS,  OR  ANY OTHER CLAIM-RELATED FINANCIAL OBLIGATIONS COVERED BY
 THE PROVIDER CONTRACT TO ANY ENROLLEE, GROUP OR OTHER  ENTITY  RECEIVING
 HEALTH CARE SERVICES PURSUANT TO THE CONTRACT.
   (2)  BEGINNING  JANUARY  FIRST, TWO THOUSAND TWENTY-TWO, ANY CONTRACT,
 WRITTEN POLICY, WRITTEN PROCEDURE OR AGREEMENT THAT  CONTAINS  A  CLAUSE
 CONTRARY  TO  THE PROVISIONS SET FORTH IN THIS SECTION SHALL BE NULL AND
 VOID; PROVIDED, HOWEVER, THE REMAINING CLAUSES  OF  THE  CONTRACT  SHALL
 REMAIN IN EFFECT FOR THE DURATION OF THE CONTRACT TERM.
   §  2. Section 4406 of the public health law is amended by adding a new
 subdivision 6 to read as follows:
   6. (A) NO HEALTH MAINTENANCE ORGANIZATION THAT OFFERS A  MANAGED  CARE
 PRODUCT  OR  A COMPREHENSIVE POLICY THAT UTILIZES A NETWORK OF PROVIDERS
 SHALL ENTER INTO A CONTRACT, WRITTEN POLICY, WRITTEN PROCEDURE OR AGREE-
 MENT WITH ANY HEALTH CARE PROVIDER THAT:
   (I) REQUIRES THE INSURER TO INCLUDE WITHIN THE SCOPE OF  THE  CONTRACT
 ALL  COVERED  GROUPS  OF  THE INSURER, INCLUDING GROUPS OR BENEFIT FUNDS
 THAT CONTRACT WITH THE INSURER, OR AN  AFFILIATE  OF  THE  INSURER,  FOR
 ACCESS TO THE INSURER'S NETWORK OF PARTICIPATING PROVIDERS;
   (II)  REQUIRES AN INSURER TO INCLUDE ALL MEMBERS OF A PROVIDER SYSTEM,
 INCLUDING MEDICAL PRACTICE GROUPS  AND  AFFILIATED  FACILITIES,  IN  ITS
 NETWORK OF PARTICIPATING PROVIDERS;
   (III)  REQUIRES  AN INSURER, OR AN AFFILIATE OF AN INSURER, TO INCLUDE
 ALL MEMBERS OF A PROVIDER SYSTEM, INCLUDING MEDICAL PRACTICE GROUPS  AND
 AFFILIATED  FACILITIES,  IN  ALL  PRODUCTS  OFFERED BY THE INSURER OR AN
 AFFILIATE OF THE INSURER;
   (IV) RESTRICTS THE ABILITY OF AN INSURER TO CREATE OR MODIFY A  TIERED
 NETWORK  BENEFIT  PLAN  OR REQUIRES AN INSURER TO PLACE ALL MEMBERS OF A
 PROVIDER SYSTEM, INCLUDING MEDICAL PRACTICE GROUPS AND AFFILIATED FACIL-
 ITIES, IN THE SAME NETWORK TIER OR OTHERWISE  LIMITS  THE  RIGHT  OF  AN
 INSURER TO PLACE A PROVIDER IN A PARTICULAR TIER;
   (V)  PROHIBITS INSURERS FROM USING BENEFIT DESIGNS, INCLUDING WELLNESS
 PROGRAMS AND OTHER BENEFITS, TO ENCOURAGE MEMBERS TO SEEK SERVICES  FROM
 VALUE-BASED HEALTH CARE PROVIDERS;
   (VI)  CONTAINS  A  MOST-FAVORED-NATION  PROVISION;  PROVIDED, HOWEVER,
 NOTHING IN THIS SECTION SHALL BE CONSTRUED TO PROHIBIT A HEALTH  INSURER
 AND  A  PROVIDER  FROM  NEGOTIATING  PAYMENT RATES AND PERFORMANCE-BASED
 CONTRACT TERMS THAT WOULD RESULT IN THE INSURER RECEIVING A RATE THAT IS
 AS FAVORABLE, OR MORE FAVORABLE, THAN THE  RATES  NEGOTIATED  BETWEEN  A
 HEALTH CARE PROVIDER AND ANOTHER ENTITY; OR
   (VII) RESTRICTS THE ABILITY OF THE INSURER TO DISCLOSE PRICE OR QUALI-
 TY  INFORMATION,  INCLUDING  THE  ALLOWED  AMOUNT,  NEGOTIATED  RATES OR
 DISCOUNTS, OR ANY OTHER CLAIM-RELATED FINANCIAL OBLIGATIONS  COVERED  BY
 THE  PROVIDER  CONTRACT TO ANY ENROLLEE, GROUP OR OTHER ENTITY RECEIVING
 HEALTH CARE SERVICES PURSUANT TO THE CONTRACT.

 A. 8169                             3
 
   (B) AFTER JANUARY FIRST, TWO THOUSAND TWENTY-TWO, ANY CONTRACT,  WRIT-
 TEN  POLICY,  WRITTEN  PROCEDURE  OR  AGREEMENT  THAT  CONTAINS A CLAUSE
 CONTRARY TO THE PROVISIONS SET FORTH IN THIS SECTION SHALL BE  NULL  AND
 VOID;  PROVIDED,  HOWEVER,  THE  REMAINING CLAUSES OF THE CONTRACT SHALL
 REMAIN IN EFFECT FOR THE DURATION OF THE CONTRACT TERM.
   § 3. This act shall take effect January 1, 2022.