S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   2205
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 24, 2023
                                ___________
 
 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 health care contracts or agreements; and to amend a chapter
   of the laws of 2022 amending the insurance  law  relating  to  certain
   prohibited  contract  provisions,  as  proposed  in  legislative bills
   numbers S. 7199-A and A. 8169-A,  in  relation  to  the  effectiveness
   thereof
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Section 4235 of the insurance law is amended  by  adding  a
 new subsection (o) to read as follows:
   (O) (1) NO CONTRACT OR AGREEMENT BETWEEN A HEALTH PLAN SUBJECT TO THIS
 ARTICLE AND A HEALTH CARE PROVIDER, OTHER THAN A RESIDENTIAL HEALTH CARE
 FACILITY  AS  DEFINED  BY SECTION TWENTY-EIGHT HUNDRED ONE OF THE PUBLIC
 HEALTH LAW, SHALL INCLUDE A PROVISION THAT:
   (A) CONTAINS A MOST-FAVORED-NATION PROVISION; OR
   (B) RESTRICTS THE ABILITY OF A CORPORATION, AN ENTITY  THAT  CONTRACTS
 WITH  A CORPORATION FOR A PROVIDER NETWORK, OR A HEALTH CARE PROVIDER TO
 DISCLOSE: (I) ACTUAL CLAIMS COSTS; OR (II) PRICE OR QUALITY  INFORMATION
 REQUIRED  TO  BE  DISCLOSED  UNDER  FEDERAL  LAW,  INCLUDING THE ALLOWED
 AMOUNT, NEGOTIATED RATES OR DISCOUNTS, OR ANY OTHER CLAIM-RELATED FINAN-
 CIAL OBLIGATIONS, INCLUDING, BUT NOT LIMITED  TO,  PATIENT  COST-SHARING
 COVERED  BY THE PROVIDER CONTRACT TO ANY SUBSCRIBER, ENROLLEE, GROUP, OR
 OTHER ENTITY RECEIVING HEALTH CARE SERVICES PURSUANT TO THE CONTRACT, OR
 TO ANY PUBLIC COMPILATION OF REIMBURSEMENT DATA SUCH AS THE NEW YORK ALL
 PAYER DATABASE REQUIRED BY LAW OR REGULATION, PROVIDED THAT  NO  DISCLO-
 SURE  SHALL  INCLUDE  PROTECTED  HEALTH INFORMATION OR OTHER INFORMATION
 COVERED BY STATUTORY OR OTHER PRIVILEGE.
   (2) FOR PURPOSES OF THIS SUBSECTION,  THE  TERM  "HEALTH  PLAN"  SHALL
 INCLUDE:  (A)  AN  INSURER LICENSED PURSUANT TO THIS CHAPTER OR A HEALTH
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD04298-01-3
              

 A. 2205                             2
 
 MAINTENANCE ORGANIZATION CERTIFIED PURSUANT TO ARTICLE FORTY-FOUR OF THE
 PUBLIC HEALTH LAW; AND
   (B)  A THIRD-PARTY ADMINISTRATOR, AFFILIATED WITH AN INSURER OR HEALTH
 MAINTENANCE ORGANIZATION, WHO ADMINISTERS A HEALTH BENEFIT PLAN.
   § 2. Section 4406-c of the public health law is amended  by  adding  a
 new subdivision 13 to read as follows:
   13. (A) NO CONTRACT OR AGREEMENT BETWEEN A HEALTH PLAN SUBJECT TO THIS
 ARTICLE AND A HEALTH CARE PROVIDER, OTHER THAN A RESIDENTIAL HEALTH CARE
 FACILITY AS DEFINED BY SECTION TWENTY-EIGHT HUNDRED ONE OF THIS CHAPTER,
 SHALL INCLUDE A PROVISION THAT:
   (I) CONTAINS A MOST-FAVORED-NATION PROVISION; OR
   (II)  RESTRICTS THE ABILITY OF A HEALTH PLAN, AN ENTITY THAT CONTRACTS
 WITH A HEALTH CARE PLAN FOR A PROVIDER NETWORK, OR A HEALTH CARE PROVID-
 ER TO DISCLOSE: (A) ACTUAL CLAIMS COSTS; OR (B) PRICE OR QUALITY  INFOR-
 MATION REQUIRED TO BE DISCLOSED UNDER FEDERAL LAW, INCLUDING THE ALLOWED
 AMOUNT, NEGOTIATED RATES OR DISCOUNTS, OR ANY OTHER CLAIM-RELATED FINAN-
 CIAL  OBLIGATIONS,  INCLUDING,  BUT NOT LIMITED TO, PATIENT COST-SHARING
 COVERED BY THE PROVIDER CONTRACT TO ANY SUBSCRIBER, ENROLLEE, GROUP,  OR
 OTHER ENTITY RECEIVING HEALTH CARE SERVICES PURSUANT TO THE CONTRACT, OR
 TO ANY PUBLIC COMPILATION OF REIMBURSEMENT DATA SUCH AS THE NEW YORK ALL
 PAYER  DATABASE  REQUIRED BY LAW OR REGULATION, PROVIDED THAT NO DISCLO-
 SURE SHALL INCLUDE PROTECTED HEALTH  INFORMATION  OR  OTHER  INFORMATION
 COVERED BY STATUTORY OR OTHER PRIVILEGE.
   (B)  FOR  PURPOSES  OF  THIS SUBDIVISION, THE TERM "HEALTH PLAN" SHALL
 INCLUDE:
   (I) AN INSURER LICENSED PURSUANT TO THE  INSURANCE  LAW  OR  A  HEALTH
 MAINTENANCE ORGANIZATION CERTIFIED PURSUANT TO THIS ARTICLE; AND
   (II) A THIRD-PARTY ADMINISTRATOR, AFFILIATED WITH AN INSURER OR HEALTH
 MAINTENANCE ORGANIZATION, WHO ADMINISTERS A HEALTH BENEFIT PLAN.
   § 3. Section 2 of a chapter of the laws of 2022 amending the insurance
 law  relating  to certain prohibited contract provisions, as proposed in
 legislative bills numbers S. 7199-A and A. 8169-A, is amended to read as
 follows:
   § 2. This act shall take effect [January] JULY 1, 2023.
   § 4. This act shall take effect immediately, provided,  however,  that
 sections  one and two of this act shall take effect on the same date and
 in the same manner as a chapter of the laws of 2022 amending the  insur-
 ance law relating to certain prohibited contract provisions, as proposed
 in legislative bills numbers S. 7199-A and A. 8169-A, takes effect.