Legislation
SECTION 24
Disclosure
Public Health (PBH) CHAPTER 45, ARTICLE 1, TITLE 2
§ 24. Disclosure. 1. A health care professional, or a group practice
of health care professionals, a diagnostic and treatment center or a
health center defined under 42 U.S.C. § 254b on behalf of health care
professionals rendering services at the group practice, diagnostic and
treatment center or health center, shall disclose to patients or
prospective patients in writing or through an internet website the
health care plans in which the health care professional, group practice,
diagnostic and treatment center or health center, is a participating
provider and the hospitals with which the health care professional is
affiliated prior to the provision of non-emergency services and verbally
at the time an appointment is scheduled.
2. If a health care professional, or a group practice of health care
professionals, a diagnostic and treatment center or a health center
defined under 42 U.S.C. § 254b on behalf of health care professionals
rendering services at the group practice, diagnostic and treatment
center or health center, does not participate in the network of a
patient's or prospective patient's health care plan, the health care
professional, group practice, diagnostic and treatment center or health
center, shall: (a) prior to the provision of non-emergency services,
inform a patient or prospective patient that the amount or estimated
amount the health care professional will bill the patient for health
care services is available upon request; and (b) upon receipt of a
request from a patient or prospective patient, disclose to the patient
or prospective patient in writing the amount or estimated amount or,
with respect to a health center, a schedule of fees provided under 42
U.S.C. § 254b(k)(3)(G)(i), that the health care professional, group
practice, diagnostic and treatment center or health center, will bill
the patient or prospective patient for health care services provided or
anticipated to be provided to the patient or prospective patient absent
unforeseen medical circumstances that may arise when the health care
services are provided.
3. A health care professional who is a physician shall provide a
patient or prospective patient with the name, practice name, mailing
address, and telephone number of any health care provider scheduled to
perform anesthesiology, laboratory, pathology, radiology or assistant
surgeon services in connection with care to be provided in the
physician's office for the patient or coordinated or referred by the
physician for the patient at the time of referral to or coordination of
services with such provider.
4. A health care professional who is a physician shall, for a
patient's scheduled hospital admission or scheduled outpatient hospital
services, provide a patient and the hospital with the name, practice
name, mailing address and telephone number of any other physician whose
services will be arranged by the physician and are scheduled at the time
of the pre-admission testing, registration or admission at the time
non-emergency services are scheduled; and information as to how to
determine the healthcare plans in which the physician participates.
5. A hospital shall establish, update and make public through posting
on the hospital's website, to the extent required by federal guidelines,
a list of the hospital's standard charges for items and services
provided by the hospital, including for diagnosis-related groups
established under section 1886(d)(4) of the federal social security act.
6. A hospital shall post on the hospital's website: (a) the health
care plans in which the hospital is a participating provider; (b) a
statement that (i) physician services provided in the hospital are not
included in the hospital's charges; (ii) physicians who provide services
in the hospital may or may not participate with the same health care
plans as the hospital, and; (iii) the prospective patient should check
with the physician arranging for the hospital services to determine the
health care plans in which the physician participates; (c) as
applicable, the name, mailing address and telephone number of the
physician groups that the hospital has contracted with to provide
services including anesthesiology, pathology or radiology, and
instructions how to contact these groups to determine the health care
plan participation of the physicians in these groups; and (d) as
applicable, the name, mailing address, and telephone number of
physicians employed by the hospital and whose services may be provided
at the hospital, and the health care plans in which they participate.
7. In registration or admission materials provided in advance of
non-emergency hospital services, a hospital shall: (a) advise the
patient or prospective patient to check with the physician arranging the
hospital services to determine: (i) the name, practice name, mailing
address and telephone number of any other physician whose services will
be arranged by the physician; and (ii) whether the services of
physicians who are employed or contracted by the hospital to provide
services including anesthesiology, pathology and/or radiology are
reasonably anticipated to be provided to the patient; and (b) provide
patients or prospective patients with information as to how to timely
determine the health care plans participated in by physicians who are
reasonably anticipated to provide services to the patient at the
hospital, as determined by the physician arranging the patient's
hospital services, and who are employees of the hospital or contracted
by the hospital to provide services including anesthesiology, radiology
and/or pathology.
8. A health care professional, or a group practice of health care
professionals, a diagnostic and treatment center or a health center
defined under 42 U.S.C. § 254b on behalf of health care professionals
rendering services at the group practice, diagnostic and treatment
center or health center, and a hospital shall make publicly available,
and if applicable, post on their public websites, and provide to
individuals who are enrollees of health care plans, a one-page written
notice, in clear and understandable language, containing information on
the requirements and prohibitions under 42 U.S.C. §§ 300gg-131 and
300gg-132 and article six of the financial services law relating to
prohibitions on balance billing for emergency services and surprise
bills, and information on contacting appropriate state and federal
agencies if an individual believes a health care provider has violated
any requirement described in 42 U.S.C. §§ 300gg-131 and 300gg-132 or
article six of the financial services law.
9. For purposes of this section:
(a) "Health care plan" means a health insurer including an insurer
licensed to write accident and health insurance subject to article
thirty-two of the insurance law; a corporation organized pursuant to
article forty-three of the insurance law; a municipal cooperative health
benefit plan certified pursuant to article forty-seven of the insurance
law; a health maintenance organization certified pursuant to article
forty-four of this chapter; a student health plan established or
maintained pursuant to section one thousand one hundred twenty-four of
the insurance law or a self-funded employee welfare benefit plan.
(b) "Health care professional" means an appropriately licensed,
registered or certified health care professional pursuant to title eight
of the education law.
(c) "Hospital" means a general hospital as defined in subdivision ten
of section two thousand eight hundred one of this chapter.
of health care professionals, a diagnostic and treatment center or a
health center defined under 42 U.S.C. § 254b on behalf of health care
professionals rendering services at the group practice, diagnostic and
treatment center or health center, shall disclose to patients or
prospective patients in writing or through an internet website the
health care plans in which the health care professional, group practice,
diagnostic and treatment center or health center, is a participating
provider and the hospitals with which the health care professional is
affiliated prior to the provision of non-emergency services and verbally
at the time an appointment is scheduled.
2. If a health care professional, or a group practice of health care
professionals, a diagnostic and treatment center or a health center
defined under 42 U.S.C. § 254b on behalf of health care professionals
rendering services at the group practice, diagnostic and treatment
center or health center, does not participate in the network of a
patient's or prospective patient's health care plan, the health care
professional, group practice, diagnostic and treatment center or health
center, shall: (a) prior to the provision of non-emergency services,
inform a patient or prospective patient that the amount or estimated
amount the health care professional will bill the patient for health
care services is available upon request; and (b) upon receipt of a
request from a patient or prospective patient, disclose to the patient
or prospective patient in writing the amount or estimated amount or,
with respect to a health center, a schedule of fees provided under 42
U.S.C. § 254b(k)(3)(G)(i), that the health care professional, group
practice, diagnostic and treatment center or health center, will bill
the patient or prospective patient for health care services provided or
anticipated to be provided to the patient or prospective patient absent
unforeseen medical circumstances that may arise when the health care
services are provided.
3. A health care professional who is a physician shall provide a
patient or prospective patient with the name, practice name, mailing
address, and telephone number of any health care provider scheduled to
perform anesthesiology, laboratory, pathology, radiology or assistant
surgeon services in connection with care to be provided in the
physician's office for the patient or coordinated or referred by the
physician for the patient at the time of referral to or coordination of
services with such provider.
4. A health care professional who is a physician shall, for a
patient's scheduled hospital admission or scheduled outpatient hospital
services, provide a patient and the hospital with the name, practice
name, mailing address and telephone number of any other physician whose
services will be arranged by the physician and are scheduled at the time
of the pre-admission testing, registration or admission at the time
non-emergency services are scheduled; and information as to how to
determine the healthcare plans in which the physician participates.
5. A hospital shall establish, update and make public through posting
on the hospital's website, to the extent required by federal guidelines,
a list of the hospital's standard charges for items and services
provided by the hospital, including for diagnosis-related groups
established under section 1886(d)(4) of the federal social security act.
6. A hospital shall post on the hospital's website: (a) the health
care plans in which the hospital is a participating provider; (b) a
statement that (i) physician services provided in the hospital are not
included in the hospital's charges; (ii) physicians who provide services
in the hospital may or may not participate with the same health care
plans as the hospital, and; (iii) the prospective patient should check
with the physician arranging for the hospital services to determine the
health care plans in which the physician participates; (c) as
applicable, the name, mailing address and telephone number of the
physician groups that the hospital has contracted with to provide
services including anesthesiology, pathology or radiology, and
instructions how to contact these groups to determine the health care
plan participation of the physicians in these groups; and (d) as
applicable, the name, mailing address, and telephone number of
physicians employed by the hospital and whose services may be provided
at the hospital, and the health care plans in which they participate.
7. In registration or admission materials provided in advance of
non-emergency hospital services, a hospital shall: (a) advise the
patient or prospective patient to check with the physician arranging the
hospital services to determine: (i) the name, practice name, mailing
address and telephone number of any other physician whose services will
be arranged by the physician; and (ii) whether the services of
physicians who are employed or contracted by the hospital to provide
services including anesthesiology, pathology and/or radiology are
reasonably anticipated to be provided to the patient; and (b) provide
patients or prospective patients with information as to how to timely
determine the health care plans participated in by physicians who are
reasonably anticipated to provide services to the patient at the
hospital, as determined by the physician arranging the patient's
hospital services, and who are employees of the hospital or contracted
by the hospital to provide services including anesthesiology, radiology
and/or pathology.
8. A health care professional, or a group practice of health care
professionals, a diagnostic and treatment center or a health center
defined under 42 U.S.C. § 254b on behalf of health care professionals
rendering services at the group practice, diagnostic and treatment
center or health center, and a hospital shall make publicly available,
and if applicable, post on their public websites, and provide to
individuals who are enrollees of health care plans, a one-page written
notice, in clear and understandable language, containing information on
the requirements and prohibitions under 42 U.S.C. §§ 300gg-131 and
300gg-132 and article six of the financial services law relating to
prohibitions on balance billing for emergency services and surprise
bills, and information on contacting appropriate state and federal
agencies if an individual believes a health care provider has violated
any requirement described in 42 U.S.C. §§ 300gg-131 and 300gg-132 or
article six of the financial services law.
9. For purposes of this section:
(a) "Health care plan" means a health insurer including an insurer
licensed to write accident and health insurance subject to article
thirty-two of the insurance law; a corporation organized pursuant to
article forty-three of the insurance law; a municipal cooperative health
benefit plan certified pursuant to article forty-seven of the insurance
law; a health maintenance organization certified pursuant to article
forty-four of this chapter; a student health plan established or
maintained pursuant to section one thousand one hundred twenty-four of
the insurance law or a self-funded employee welfare benefit plan.
(b) "Health care professional" means an appropriately licensed,
registered or certified health care professional pursuant to title eight
of the education law.
(c) "Hospital" means a general hospital as defined in subdivision ten
of section two thousand eight hundred one of this chapter.