S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   2376
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 25, 2023
                                ___________
 
 Introduced by M. of A. WEPRIN -- read once and referred to the Committee
   on Insurance
 
 AN ACT to amend the public health law and the insurance law, in relation
   to the reimbursement of out-of-network providers of clinical laborato-
   ry  services  by  organizations  providing  or  offering comprehensive
   health services plans

   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1. Section 4406 of the public health law is amended by adding
 a new subdivision 6 to read as follows:
   6. NOTWITHSTANDING ANY OTHER PROVISION  OF  LAW,  IF  AN  ENROLLEE  IS
 REFERRED  BY  AN  IN-PLAN  PROVIDER TO A PROVIDER OF CLINICAL LABORATORY
 SERVICES NOT PARTICIPATING IN THE PLAN (A "NON-PARTICIPATING  PROVIDER")
 FOR  ANY  SERVICE  COVERED UNDER THE TERMS OF THE PLAN, THE ORGANIZATION
 SHALL BE RESPONSIBLE  FOR  PAYMENT  DIRECTLY  TO  THE  NON-PARTICIPATING
 PROVIDER  FOR  THOSE SERVICES IN ACCORDANCE WITH THE TIME FRAME FOR SUCH
 PAYMENTS SET FORTH IN SECTION THREE THOUSAND TWO  HUNDRED  TWENTY-FOUR-A
 OF  THE  INSURANCE  LAW;  PROVIDED,  HOWEVER, THAT THE ENROLLEE SHALL BE
 RESPONSIBLE FOR ANY APPLICABLE COPAY, COINSURANCE OR DEDUCTIBLE FOR SUCH
 SERVICES. CLINICAL LABORATORIES SEEKING REIMBURSEMENT PURSUANT  TO  THIS
 SECTION FOR SERVICES RENDERED SHALL DIRECTLY BILL THE ORGANIZATION WHOSE
 ENROLLEE  RECEIVED  THE  SERVICES.  ANY  PAYMENT MADE BY AN ORGANIZATION
 DIRECTLY TO THE ENROLLEE RATHER THAN TO THE CLINICAL LABORATORY  SEEKING
 REIMBURSEMENT SHALL NOT SATISFY THE ORGANIZATION'S PAYMENT OBLIGATION TO
 THE CLINICAL LABORATORY.
   §  2.  Section  4804  of  the insurance law is amended by adding a new
 subsection (g) to read as follows:
   (G) NOTWITHSTANDING ANY OTHER PROVISION OF  LAW,  IF  AN  ENROLLEE  IS
 REFERRED  BY  AN  IN-PLAN  PROVIDER TO A PROVIDER OF CLINICAL LABORATORY
 SERVICES NOT PARTICIPATING IN THE PLAN (A "NON-PARTICIPATING  PROVIDER")
 FOR  ANY  SERVICE  COVERED UNDER THE TERMS OF THE PLAN, THE ORGANIZATION
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD01446-01-3
              

 A. 2376                             2
 
 SHALL BE RESPONSIBLE  FOR  PAYMENT  DIRECTLY  TO  THE  NON-PARTICIPATING
 PROVIDER  FOR  THOSE SERVICES IN ACCORDANCE WITH THE TIME FRAME FOR SUCH
 PAYMENTS SET FORTH IN SECTION THREE THOUSAND TWO  HUNDRED  TWENTY-FOUR-A
 OF THIS CHAPTER; PROVIDED, HOWEVER, THAT THE ENROLLEE SHALL BE RESPONSI-
 BLE  FOR  ANY  APPLICABLE  COPAY,  COINSURANCE  OR  DEDUCTIBLE  FOR SUCH
 SERVICES. CLINICAL LABORATORIES SEEKING REIMBURSEMENT PURSUANT  TO  THIS
 SECTION FOR SERVICES RENDERED SHALL DIRECTLY BILL THE ORGANIZATION WHOSE
 ENROLLEE  RECEIVED  THE  SERVICES.  ANY  PAYMENT MADE BY AN ORGANIZATION
 DIRECTLY TO THE ENROLLEE RATHER THAN TO THE CLINICAL LABORATORY  SEEKING
 REIMBURSEMENT SHALL NOT SATISFY THE ORGANIZATION'S PAYMENT OBLIGATION TO
 THE CLINICAL LABORATORY.
   § 3. This act shall take effect immediately.