NY State Senate Bill 2021-S8029

Archive: Last Bill Status - In Senate Committee Insurance 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

Please enter your contact information

First Name

Last Name

Email Address

A valid email address is required.

Home address is used to determine the senate district in which you reside. Your support or opposition to this bill is then shared immediately with the senator who represents you.

Optional services from the NY State Senate:

Create an account. An account allows you to officially support or oppose key legislation, sign petitions with a single click, and follow issues, committees, and bills that matter to you. When you create an account, you agree to this platform's terms of participation.

Include a custom message for your Senator? (Optional)

Enter a message to your senator. Many New Yorkers use this to share the reasoning behind their support or opposition to the bill. Others might share a personal anecdote about how the bill would affect them or people they care about.

Actions

View Actions

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 20, 2022	referred to insurance

2021-S8029 (ACTIVE) - Details

Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §3217-b, Ins L; amd §4406, Pub Health L
Versions Introduced in 2023-2024 Legislative Session:: S6973

2021-S8029 (ACTIVE) - Summary

Prohibits an insurer or health maintenance organization from including certain requirements in insurance contracts.

2021-S8029 (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S8029

SPONSOR: CLEARE
 
TITLE OF BILL:

An act to amend the insurance law and the public health law, in relation
to prohibiting certain requirements in insurance contracts

 
PURPOSE:

The legislation would ban anti-competitive hospital contracting prac-
tices that create higher health care prices for consumers and employers.

 
SUMMARY OF PROVISIONS:

Section one amends the insurance law to prohibit health plans from
entering into agreements or contracts with health care providers that
require the health plan to include all members of a provider group in
its network, require the health plan to place all members of a provider
group in the same network tier, require the health plan to include all
members of a provider group in all of its-products, forbid health plans
from using benefit design to encourage consumers to seek services from

higher-value health care providers; contain most-favored-nation
provisions in which the provider will not give an equal or more favora-
ble price to any other plan; or limit the ability of the health plans or
provider from disclosing fees for services or the allowed amounts. Such
provisions in existing-contracts would become null and void effective
January 1, 2021.

Section two amends the public health law to prohibit health plans from
entering into agreements or contracts with health care providers that
require the health plan to include all members of a provider group in
its network, require the health plan to place all members of a provider
group in the same network tier, require the health plan to include all
members of a provider group in all of its products, forbid health plans
from using benefit design to encourage consumers to seek services from
higher-value health care providers, contain most-favored-nation
provisions in which the provider will not give an equal or more favora-
ble price to any other plan, or limit the ability of the health plans or
provider from disclosing fees for services or the allowed amounts. Such
provisions in existing contracts would become null and void effective
January 1, 2021.

Section three provides the effective date.

 
JUSTIFICATION:

According to multiple studies, the cost of health care in New York
continues to exceed the national average, with increases in prices
charged by provides as one of the major driver of rising health insur-
ance premiums. According to the NY State Health Foundation's December
2016 report, Why are Hospital Prices Different? An Examination of New
York Hospital Reimbursement, "a hospital's market leverage - its bargain
power when negotiation with insurers - is a key factor in the prices a
hospital can command," and "contract provisions between hospitals and
insurers can hinder competition, product innovation, transparency, and
cost containment strategies."  To maintain access to health care for New
Yorkers and support a competitive market for the industry, the report
recommended barring certain contractual language from hospital/insurer
contracts, and that policies could include the barring of confidentiali-
ty language, anti-steering language, and language that hinders the abil-
ity of the.  tiered network product to work efficiently.

This legislation builds upon the Foundation's recommendations and seeks
to improve affordability for employers and consumers by prohibiting
restrictive contracting language that create artificial barriers to
promoting greater competition in the marketplace, increasing transparen-
cy of health care costs, and providing more affordable options for
employers and consumers.

As an example, "all-or-nothing" contracts require that if a health plan
wants a contract with any provider or affiliate in a particular provider
organization, it must contract with all providers in the system. Provid-
er organizations use this type of provision to leverage the status of
their must-have providers to demand high payment rates for the entire
provider organization, including those providers in more competitive
areas and specialties. Similarly, restrictive contract provisions some-
times require that a health plan place all physicians, hospitals, and
other facilities associated with the dominant provider system in the
most favorable tier of providers.  This legislation provides an equita-
ble balance for hospitals contracting with health plans and employer
groups, by allowing for competition, fair negotiations, and ensure
consumers benefits. The legislation would help address the issue of
pricing fairness and access to affordable health care in the state as
well as help ensure that New Yorkers are not subjected to unfair busi-
ness practices that increase health insurance premiums.

 
LEGISLATIVE HISTORY:

2020: A.9781

 
FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
This act shall take effect January 1, 2023.

2021-S8029 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   8029
 
                             I N  S E N A T E
 
                             January 20, 2022
                                ___________
 
 Introduced  by  Sen.  CLEARE -- read twice and ordered printed, and when
   printed to be committed to the Committee on Insurance
 
 AN ACT to amend the insurance law and the public health law, in relation
   to prohibiting certain requirements in insurance contracts
 
   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 WITH ANY HEALTH
 CARE PROVIDER THAT:
   (A) REQUIRES AN INSURER TO INCLUDE ALL MEMBERS OF  A  PROVIDER  GROUP,
 INCLUDING  MEDICAL  PRACTICE  GROUPS  AND  FACILITIES, IN ITS NETWORK OF
 PARTICIPATING PROVIDERS;
   (B) REQUIRES AN INSURER TO PLACE ALL  MEMBERS  OF  A  PROVIDER  GROUP,
 INCLUDING  MEDICAL  PRACTICE  GROUPS AND FACILITIES, IN THE SAME NETWORK
 TIER;
   (C) REQUIRES AN INSURER TO INCLUDE ALL MEMBERS OF  A  PROVIDER  GROUP,
 INCLUDING  MEDICAL  PRACTICE  GROUPS  AND  FACILITIES,  IN  ALL PRODUCTS
 OFFERED BY THE INSURER;
   (D) PROHIBITS INSURERS FROM USING BENEFIT DESIGNS TO ENCOURAGE MEMBERS
 TO SEEK SERVICES FROM HIGHER-VALUE HEALTH CARE PROVIDERS;
   (E) 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; AND
   (F) LIMITS THE ABILITY OF THE INSURER OR  HEALTH  CARE  PROVIDER  FROM
 DISCLOSING  FEES  FOR  SERVICES  OR THE ALLOWED AMOUNTS TO AN INSURED OR
 INSURED'S HEALTH CARE PROVIDER.
   (2) AFTER JANUARY FIRST,  TWO  THOUSAND  TWENTY-THREE,  ANY  CONTRACT,
 WRITTEN  POLICY,  WRITTEN  PROCEDURE OR AGREEMENT THAT CONTAINS A CLAUSE
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD04975-03-2
 S. 8029                             2
 
 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 AN INSURER TO INCLUDE ALL MEMBERS OF  A  PROVIDER  GROUP,
 INCLUDING  MEDICAL  PRACTICE  GROUPS  AND  FACILITIES, IN ITS NETWORK OF
 PARTICIPATING PROVIDERS;
   (II) REQUIRES AN INSURER TO PLACE ALL MEMBERS  OF  A  PROVIDER  GROUP,
 INCLUDING  MEDICAL  PRACTICE  GROUPS AND FACILITIES, IN THE SAME NETWORK
 TIER;
   (III) REQUIRES AN INSURER TO INCLUDE ALL MEMBERS OF A PROVIDER  GROUP,
 INCLUDING  MEDICAL  PRACTICE  GROUPS  AND  FACILITIES,  IN  ALL PRODUCTS
 OFFERED BY THE INSURER;
   (IV) PROHIBITS  INSURERS  FROM  USING  BENEFIT  DESIGNS  TO  ENCOURAGE
 MEMBERS TO SEEK SERVICES FROM HIGHER-VALUE HEALTH CARE PROVIDERS;
   (V) 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; AND
   (VI)  LIMITS  THE  ABILITY OF THE INSURER OR HEALTH CARE PROVIDER FROM
 DISCLOSING FEES FOR SERVICES OR THE ALLOWED AMOUNTS  TO  AN  INSURED  OR
 INSURED'S HEALTH CARE PROVIDER.
   (B)  AFTER  JANUARY  FIRST,  TWO  THOUSAND TWENTY-THREE, 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.
   § 3. This act shall take effect January 1, 2023.

Comments

Open Legislation is a forum for New York State legislation. All comments are subject to review and community moderation is encouraged.

Comments deemed off-topic, commercial, campaign-related, self-promotional; or that contain profanity, hate or toxic speech; or that link to sites outside of the nysenate.gov domain are not permitted, and will not be published. Attempts to intimidate and silence contributors or deliberately deceive the public, including excessive or extraneous posting/posts, or coordinated activity, are prohibited and may result in the temporary or permanent banning of the user. Comment moderation is generally performed Monday through Friday. By contributing or voting you agree to the Terms of Participation and verify you are over 13.

Create an account. An account allows you to sign petitions with a single click, officially support or oppose key legislation, and follow issues, committees, and bills that matter to you. When you create an account, you agree to this platform's terms of participation.

Senate Bill S8029

Sponsored By

Archive: Last Bill Status - In Senate Committee Insurance Committee

2021-S8029 (ACTIVE) - Details

2021-S8029 (ACTIVE) - Summary

2021-S8029 (ACTIVE) - Sponsor Memo

2021-S8029 (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S8029

Share this bill

Sponsored By

Cordell Cleare

Archive: Last Bill Status - In Senate Committee Insurance Committee

2021-S8029 (ACTIVE) - Details

2021-S8029 (ACTIVE) - Summary

2021-S8029 (ACTIVE) - Sponsor Memo

2021-S8029 (ACTIVE) - Bill Text download pdf

Comments