New York S 10317: Provides for network participation verification and disclosure

Bill Text

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S10317 Summary:

BILL NOS10317 

&nbsp

SAME ASNo Same As

&nbsp

SPONSORJACKSON

&nbsp

COSPNSR

&nbsp

MLTSPNSR

&nbsp

Add §§25 & 4406-j, Pub Health L; add §§3217-k & 4306-j, Ins L

&nbsp

Requires health care providers to verify and disclose their in- or out-of-network status with a prospective patient's health plan.

Go to top S10317 Actions:

BILL NOS10317 

&nbsp

05/13/2026REFERRED TO HEALTH

Go to topS10317 Committee&nbspVotes:

Go to topS10317 Floor&nbspVotes:

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

Go to topS10317 Text:

 STATE OF NEW YORK
 ________________________________________________________________________

 10317

 IN SENATE

 May 13, 2026
 ___________

 Introduced by Sen. JACKSON -- read twice and ordered printed, and when
 printed to be committed to the Committee on Health

 AN ACT to amend the public health law and the insurance law, in relation
 to network participation verification and disclosure

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

 1 Section 1. Legislative findings and intent. The legislature finds that
 2 patients routinely rely on representations by health care providers
 3 regarding participation in a health plan's network. Providers frequently
 4 state they are "in-network" based on outdated or incomplete information,
 5 resulting in unexpected out-of-network charges and financial harm.
 6 Existing law requires insurers to maintain accurate provider directories
 7 but imposes no corresponding duty on providers to verify their contrac-
 8 tual status prior to communicating with patients. This act establishes a
 9 clear, enforceable requirement for real-time verification and disclo-
 10 sure, and provides consumer protections when such verification does not
 11 occur.
 12 § 2. The public health law is amended by adding a new section 25 to
 13 read as follows:
 14 § 25. Network participation verification and disclosure. 1. Defi-
 15 nitions. For purposes of this section:
 16 (a) "Health care provider" means any individual or entity licensed,
 17 certified or authorized to provide health care services in this state.
 18 (b) "Insurer" means any insurer, health maintenance organization, or
 19 health benefit plan subject to the insurance law or this chapter.
 20 (c) "Network participation status" means whether a provider is
 21 contracted as a participating provider under a specific health benefit
 22 plan.
 23 (d) "Real-time verification" means an electronic or telephonic confir-
 24 mation obtained directly from the insurer or its designated verification
 25 system within the preceding seventy-two hours.
 26 2. Verification requirement. No health care provider, or employee or
 27 agent thereof shall represent, state, imply or confirm to a patient or
 28 prospective patient that the provider is in-network, participating, or

 EXPLANATION--Matter in italics (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD15153-01-6

 S. 10317 2

 1 otherwise contracted with a health plan unless real-time verification of
 2 network participation status has been completed.
 3 3. Pre-service documentation and disclosure. (a) Prior to scheduling
 4 an appointment or rendering any non-emergency service, a provider shall
 5 furnish the patient with written or electronic documentation stating:
 6 (i) that real-time verification was completed; and
 7 (ii) whether the provider is in-network or out-of-network for the
 8 patient's specific health plan.
 9 (b) If the provider is out-of-network, the documentation shall state
 10 that services will be billed at out-of-network rates and may result in
 11 higher out-of-pocket costs.
 12 (c) Documentation shall be acknowledged by the patient prior to
 13 service.
 14 4. Documentation retention. (a) If the patient is billed at the
 15 in-network rate or lower, the provider shall not be required to retain
 16 or produce proof of real-time verification.
 17 (b) If the patient is billed at out-of-network rates, the provider
 18 shall retain all verification and disclosure documentation for three
 19 years from the date of service.
 20 (c) Proof of real-time verification shall be required only when the
 21 provider bills out-of-network.
 22 5. Penalty for failure to disclose. (a) A provider tha