S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                    832
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                                (PREFILED)
 
                              January 6, 2021
                                ___________
 
 Introduced  by M. of A. GOTTFRIED, DINOWITZ, ENGLEBRIGHT, GALEF, PAULIN,
   CUSICK, L. ROSENTHAL,  SAYEGH  --  Multi-Sponsored  by  --  M.  of  A.
   CARROLL, COLTON, COOK, CYMBROWITZ, GLICK, GUNTHER, PERRY, J. RIVERA --
   read once and referred to the Committee on Health

 AN ACT to amend the public health law and the insurance law, in relation
   to certain contracts or agreements by health maintenance organizations
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subdivision 7 of section 4406-c of the public  health  law,
 as added by chapter 705 of the laws of 1996 and as renumbered by chapter
 487  of  the  laws  of  2010,  is renumbered subdivision 15 and four new
 subdivisions 11, 12, 13 and 14 are added to read as follows:
   11. NO CONTRACT OR AGREEMENT BETWEEN A HEALTH CARE PLAN AND  A  HEALTH
 CARE  PROVIDER  SHALL CONTAIN ANY CLAUSE WHICH ENTITLES SUCH HEALTH CARE
 PLAN TO REIMBURSE THE HEALTH CARE PROVIDER AT THE LOWEST PRICE  OR  RATE
 THAT  SUCH HEALTH CARE PROVIDER HAS CHARGED ANOTHER PERSON OR ENTITY FOR
 RENDERING THE SAME TREATMENT OR PERFORMING THE SAME PROCEDURE.
   12. NO HEALTH CARE PLAN SHALL BY CONTRACT, WRITTEN POLICY  OR  WRITTEN
 PROCEDURE  PROHIBIT ANY HEALTH CARE PROVIDER FROM REFERRING A PATIENT OR
 ENROLLEE TO A HEALTH CARE PROVIDER BASED SOLELY UPON  SUCH  HEALTH  CARE
 PROVIDER'S PARTICIPATION STATUS WITH THE MANAGED CARE PRODUCT SUBSCRIBED
 TO BY THE PATIENT OR ENROLLEE.
   13.  NO  HEALTH CARE PLAN SHALL BY CONTRACT, WRITTEN POLICY OR WRITTEN
 PROCEDURE REQUIRE  THE  DISCLOSURE  OF  AN  ENROLLEE'S  DIAGNOSIS  ON  A
 PRESCRIPTION  AS  A CONDITION FOR DISPENSING OF A PHARMACEUTICAL DRUG OR
 AGENT, UNLESS OTHERWISE REQUIRED BY LAW.
   14. NO HEALTH CARE PLAN SHALL BY CONTRACT, WRITTEN POLICY OR PROCEDURE
 PROVIDE FOR OR ALLOW THE SUBSTITUTION OF A PHARMACEUTICAL DRUG OR  AGENT
 (OTHER  THAN  A  GENERIC  SUBSTITUTION)  BY  ANY  PERSON  OTHER THAN THE
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD00253-01-1

 A. 832                              2
 
 PRESCRIBING HEALTH CARE PROFESSIONAL OR BY A  PHARMACIST  UNDER  SECTION
 SIXTY-EIGHT HUNDRED ONE-A OF THE EDUCATION LAW.
   §  2. Subsection (h) of section 3217-b of the insurance law, as relet-
 tered by chapter 237 of the laws of 2009, is relettered  subsection  (p)
 and  four  new  subsections  (h),  (m), (n) and (o) are added to read as
 follows:
   (H) NO CONTRACT OR AGREEMENT BETWEEN AN  INSURER  AND  A  HEALTH  CARE
 PROVIDER  SHALL  CONTAIN ANY CLAUSE WHICH ENTITLES SUCH INSURER TO REIM-
 BURSE THE HEALTH CARE PROVIDER AT THE LOWEST PRICE  OR  RATE  THAT  SUCH
 HEALTH  CARE PROVIDER HAS CHARGED ANOTHER PERSON OR ENTITY FOR RENDERING
 THE SAME TREATMENT OR PERFORMING THE SAME PROCEDURE.
   (M) NO INSURER SHALL BY CONTRACT, WRITTEN POLICY OR WRITTEN  PROCEDURE
 PROHIBIT  ANY HEALTH CARE PROVIDER FROM REFERRING AN INSURED TO A PHYSI-
 CIAN BASED SOLELY UPON SUCH PHYSICIAN'S PARTICIPATION  STATUS  WITH  THE
 INSURANCE PRODUCT SUBSCRIBED TO BY THE INSURED.
   (N)  NO INSURER SHALL BY CONTRACT, WRITTEN POLICY OR WRITTEN PROCEDURE
 REQUIRE THE DISCLOSURE OF AN INSURED'S DIAGNOSIS ON A PRESCRIPTION AS  A
 CONDITION FOR AUTHORIZING THE COVERAGE FOR OR PAYMENT OR DISPENSING OF A
 PHARMACEUTICAL DRUG OR AGENT, UNLESS OTHERWISE REQUIRED BY LAW.
   (O)  NO  INSURER  WHICH MAINTAINS A DRUG FORMULARY, OR WHICH CONTRACTS
 WITH ANOTHER ENTITY TO MAINTAIN A DRUG  FORMULARY,  SHALL  BY  CONTRACT,
 WRITTEN  POLICY  OR PROCEDURE PROVIDE FOR OR ALLOW THE SUBSTITUTION OF A
 PHARMACEUTICAL DRUG OR AGENT (OTHER THAN A GENERIC SUBSTITUTION) BY  ANY
 PERSON OTHER THAN THE PRESCRIBING HEALTH CARE PROFESSIONAL OR BY A PHAR-
 MACIST UNDER SECTION SIXTY-EIGHT HUNDRED ONE-A OF THE EDUCATION LAW.
   §  3.  Subsection  (i) of section 4325 of the insurance law, as relet-
 tered by chapter 487 of the laws of 2010, is relettered  subsection  (q)
 and  four  new  subsections  (i),  (n), (o) and (p) are added to read as
 follows:
   (I) NO CONTRACT OR AGREEMENT BETWEEN AN  INSURER  AND  A  HEALTH  CARE
 PROVIDER  SHALL  CONTAIN ANY CLAUSE WHICH ENTITLES SUCH INSURER TO REIM-
 BURSE THE HEALTH CARE PROVIDER AT THE LOWEST PRICE  OR  RATE  THAT  SUCH
 HEALTH  CARE PROVIDER HAS CHARGED ANOTHER PERSON OR ENTITY FOR RENDERING
 THE SAME TREATMENT OR PERFORMING THE SAME PROCEDURE.
   (N) NO INSURER SHALL BY CONTRACT, WRITTEN POLICY OR WRITTEN  PROCEDURE
 PROHIBIT  ANY HEALTH CARE PROVIDER FROM REFERRING AN INSURED TO A PHYSI-
 CIAN BASED SOLELY UPON SUCH PHYSICIAN'S PARTICIPATION  STATUS  WITH  THE
 INSURANCE PRODUCT SUBSCRIBED TO BY THE INSURED.
   (O)  NO INSURER SHALL BY CONTRACT, WRITTEN POLICY OR WRITTEN PROCEDURE
 REQUIRE THE DISCLOSURE OF AN INSURED'S DIAGNOSIS ON A PRESCRIPTION AS  A
 CONDITION FOR AUTHORIZING THE COVERAGE FOR OR PAYMENT OR DISPENSING OF A
 PHARMACEUTICAL DRUG OR AGENT, UNLESS OTHERWISE REQUIRED BY LAW.
   (P)  NO  INSURER  WHICH MAINTAINS A DRUG FORMULARY, OR WHICH CONTRACTS
 WITH ANOTHER ENTITY TO MAINTAIN A DRUG  FORMULARY,  SHALL  BY  CONTRACT,
 WRITTEN  POLICY  OR PROCEDURE PROVIDE FOR OR ALLOW THE SUBSTITUTION OF A
 PHARMACEUTICAL DRUG OR AGENT (OTHER THAN A GENERIC SUBSTITUTION) BY  ANY
 PERSON OTHER THAN THE PRESCRIBING HEALTH CARE PROFESSIONAL OR BY A PHAR-
 MACIST UNDER SECTION SIXTY-EIGHT HUNDRED ONE-A OF THE EDUCATION LAW.
   § 4. This act shall take effect on the one hundred eightieth day after
 it shall have become a law.