New York S 4431: Provides for a right of health maintenance organization enrollees to continue to receive services from a provider who disaffiliates

Bill Text

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 Speaker Carl E. Heastie

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S04431 Summary:

BILL NOS04431 

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SAME ASSAME AS A03759

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SPONSORCOMRIE

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COSPNSR

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MLTSPNSR

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Amd §§4803 & 4804, Ins L; amd §§4403 & 4406-d, Pub Health L

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Extends period during which health maintenance organization enrollees may continue to receive services from a health care provider who disaffiliates from 60 or 90 days to 1 year, or in case of terminal illness, until the time of such insured's death; bars incentives which induce a provider to provide health care to an enrollee in a manner inconsistent with law.

Go to top S04431 Actions:

BILL NOS04431 

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02/04/2025REFERRED TO INSURANCE

01/07/2026REFERRED TO INSURANCE

Go to topS04431 Committee&nbspVotes:

Go to topS04431 Floor&nbspVotes:

There are no Assembly votes for this bill in this legislative session.

Go to topS04431 Text:

 STATE OF NEW YORK
 ________________________________________________________________________

 4431

 2025-2026 Regular Sessions

 IN SENATE

 February 4, 2025
 ___________

 Introduced by Sen. COMRIE -- 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 access to health care providers in managed care plans

 The People of the State of New York, represented in Senate and Assem-
 bly, do enact as follows:

 1 Section 1. Subsection (e) of section 4803 of the insurance law, as
 2 added by chapter 705 of the laws of 1996, is amended to read as follows:
 3 (e) No insurer shall terminate or refuse to renew a contract for
 4 participation in the in-network benefits portion of an insurer's network
 5 for a managed care product solely because the health care professional
 6 has: (1) advocated on behalf of an insured; (2) [has] filed a complaint
 7 against the insurer; (3) [has] appealed a decision of the insurer; (4)
 8 provided information or filed a report pursuant to section forty-four
 9 hundred six-c of the public health law; [or] (5) requested a hearing or
 10 review pursuant to this section; or (6) rendered an opinion regarding
 11 whether an insured's illness is terminal pursuant to section four thou-
 12 sand eight hundred four of this article.
 13 § 2. Subsections (e) and (f) of section 4804 of the insurance law,
 14 subsection (e) as amended by section 9 of subpart B of part AA of chap-
 15 ter 57 of the laws of 2022 and subsection (f) as added by chapter 705 of
 16 the laws of 1996, are amended to read as follows:
 17 (e) (1) If an insured's health care provider leaves the insurer's
 18 in-network benefits portion of its network of providers for a managed
 19 care product for reasons other than those for which the provider would
 20 not be eligible to receive a hearing pursuant to paragraph one of
 21 subsection (b) of section [forty-eight] four thousand eight hundred
 22 three of this [chapter] article, the insurer shall provide written
 23 notice to the insured of the provider's disaffiliation and permit the
 24 insured to continue [an ongoing course of treatment with] to receive
 25 health care procedures, treatments, and services from the insured's

 EXPLANATION--Matter in italics (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD05920-01-5

 S. 4431 2

 1 current health care provider during a transitional period of: (A) [nine-
 2 ty days] one year from the later of the date of the notice to the
 3 insured of the provider's disaffiliation from the insurer's network or
 4 the effective date of the provider's disaffiliation from the insurer's
 5 network; [or] (B) if the insured is pregnant at the time of the provid-
 6 er's disaffiliation, the duration of the pregnancy and post-partum care
 7 directly related to the delivery; or (C) a terminal illness or condi-
 8 tion, until the time of such insured's death.
 9 (2) During the transitional period the health care provider shall: (A)
 10 continue to accept reimbursement from the insurer at the rates applica-
 11 ble prior to the start of the transitional period, and continue to
 12 accept the in-network cost-sharing from the insured, if any, as payment
 13 in full; (B) adhere to the insurer's quality assurance requirements and
 14 provide to the insurer necessary medical information related to such
 15 care; and (C) otherwise