NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A1749
SPONSOR: Dinowitz TITLE OF BILL:
An act to amend the public health law, in relation to expanding health
care plan contract coverage for any health care provider for one hundred
twenty days after the termination of such contract
PURPOSE OR GENERAL IDEA OF BILL:
The purpose of-this bill, in instances where a contract between a health
plan and a provider is not renewed, is to extend the period of time from
two months to 120 days where a consumer with such health plan may
utilize the services of such provider under the terms of the former
contract. The bill would also provide that coverage during the 120 day
period would extend to all health care entities that are part of the
provider's organization (included in the former contract), not just
hospitals as is currently law.
SUMMARY OF SPECIFIC PROVISIONS:
Section one amends subdivision 5-d of section 4406-c of the public
health law to. provide that health plan consumers shall be able to visit
any health care provider under the terms of the former contract, when
such contract is not renewed, for a period of 120 days. Existing law
provides that consumers are only permitted to visit hospitals under the
terms of the former contract for a period of 60 days.
Section two is the effective date.
JUSTIFICATION:
When a massive health insurance company and a health care provider
organization cannot come to an agreement on rates, New Yorkers who
happen to have such insurance should be given ample time to plan for the
change in their health care access. This is especially true in areas
where one provider dominates a region's health care market. Such was
nearly the case in the Bronx where United healthcare (UHC) and Montef-
iore failed to renew their contract for over seven months, placing thou-
sands in jeopardy-of losing access to their primary care doctors and
health care services provided by Montefiore. Ultimately the two entities
came to a resolution but it highlighted the need to reexamine existing
law on this issue.
Public health law provides for a "cooling off" period of two months
where individuals, are still able to visit a provider hospital under the
terms of the former contract. The UHC/Montefiore dispute, which occurred
over the -course of 2021, demonstrated first, that.two months is simply
not enough time given the vital nature of health care coverage, and
second, that only authorizing hospital visits under the former contract,
and not all provider entities (such as primary care doctors), is insuf-
ficient.
Thankfully there is a baseline in public health law for extending cover-
age during such instances, and this bill would build on that foundation
to provide more health care security to New Yorkers.
PRIOR LEGISLATIVE HISTORY:
2021-22: A.8511 - Health / S.7758 - Health
FISCAL IMPLICATIONS:
Undetermined.
EFFECTIVE DATE:
This act shall take effect immediately; provided, however that the
amendments to subdivision 5-d of section 4406-c of the public health law
made by section one of this act shall not affect the repeal of such
subdivision and shall be deemed repealed therewith.
STATE OF NEW YORK
________________________________________________________________________
1749
2023-2024 Regular Sessions
IN ASSEMBLY
January 20, 2023
___________
Introduced by M. of A. DINOWITZ -- read once and referred to the Commit-
tee on Health
AN ACT to amend the public health law, in relation to expanding health
care plan contract coverage for any health care provider for one
hundred twenty days after the termination of such contract
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subdivision 5-d of section 4406-c of the public health law,
2 as added by chapter 451 of the laws of 2007, and as relettered by chap-
3 ter 237 of the laws of 2009, is amended to read as follows:
4 5-d. If a contract between a plan and [a hospital] any health care
5 provider is not renewed or is terminated by either party, the parties
6 shall continue to abide by the terms of such contract, including
7 reimbursement terms, for a period of [two months] one hundred twenty
8 days from the effective date of termination or, in the case of a non-re-
9 newal, from the end of the contract period. Notice shall be provided to
10 all enrollees potentially affected by such termination or non-renewal
11 within fifteen days after commencement of the [two-months] one hundred
12 twenty day period. The commissioner shall have the authority to waive
13 the [two-months] one hundred twenty day period upon the request of
14 either party to a contract that is being terminated for cause. This
15 subdivision shall not apply where both parties mutually agree in writing
16 to the termination or non-renewal and the plan provides notice to the
17 enrollee at least thirty days in advance of the date of contract termi-
18 nation.
19 § 2. This act shall take effect immediately; provided, however that
20 the amendments to subdivision 5-d of section 4406-c of the public
21 health law made by section one of this act shall not affect the repeal
22 of such subdivision and shall be deemed repealed therewith.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD01379-01-3
