BILL NUMBER: S4922

SPONSOR: SEPULVEDA
 
TITLE OF BILL:

An act to amend the public health law, in relation to prohibiting
approved organizations in the child health insurance plan from limiting
the participation of certain health care providers

 
PURPOSE OR GENERAL IDEA:

This bill would prohibit insurance companies that administer the Child
Health Plus program from requiring that participating health care
providers also sign up for the commercial health care network operated
by the insurer.

 
SUMMARY OF SPECIFIC PROVISIONS:

This bill would add a new paragraph (d) to subdivision 7 of section 2511
of the Public Health Law to prohibit an approved organization adminis-
tering the Child Health Plus program from denying or limiting the
provision of health care services by a provider on the grounds that the
              

provider refuses to participate in a commercial health care network
maintained by the organization.

 
JUSTIFICATION:

Child Health Plus is a publicly funded insurance assistance program
intended to meet the health needs of children who have limited or no
health insurance. The program is administered by insurance companies
which may also include commercial health maintenance organization (HMO)
programs.

Some insurance companies that administer Child Health Plus are using the
state-funded Child Health Plus program as bait for their commercial,
profit-making activities. These companies are forcing health care
providers who want to serve uninsured children through the Child Health
Plus program to participate in the insurer's commercial HMO.

Doctors who refuse to join the commercial HMO are denied the opportunity
to provide state-funded health care to uninsured children. This bill
would prohibit the discriminatory practice by health insurance compa-
nies. Under the bill, doctors who want to serve uninsured children
through the Child Health Plus program would be able to do so without
being forced to participate in a commercial HMO. As a result, families
of uninsured children would have better access to health care through a
greater choice of pediatricians and other health care providers.

 
LEGISLATIVE HISTORY:

S.2212 of 2021-22: Passed both houses, Vetoed and Tabled;

S.6760 of 2020: Referred to Health;

S.6760 of 2019: Referred to Rules;

S.8744 of 2017-18: Referred to Health;

A.2918 of 2016: Referred to Health, Advanced to third reading Cal.365;
A.2918 of 2015: Referred to Health, Advanced to third reading Cal.188;

A.4045 of 2014: Passed Assembly, Referred to Senate Health;

A.4045 of 2013: Referred to Health;

A.2550 of 2012: Passed Assembly, Referred to Senate Health;

A.2550 of 2011: Passed Assembly, Referred to Senate Health

 
FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
This act shall take effect immediately.