Requires Medicare and Medicaid managed care providers to provide coverage for certain out-of-network health care when the patient has a long term relationship with a medical professional who is not a recurring provider under the managed care provider's network.
STATE OF NEW YORK
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6465
2023-2024 Regular Sessions
IN ASSEMBLY
April 11, 2023
___________
Introduced by M. of A. CHANDLER-WATERMAN -- read once and referred to
the Committee on Health
AN ACT to amend the social services law, in relation to requiring Medi-
care and Medicaid managed care providers to provide coverage for out-
of-network health care under certain circumstances
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Short Title. This act shall be known and may be cited as
2 the "patient choice of health care provider protection act".
3 § 2. Clause (F) of subparagraph (iii) of paragraph (a) of subdivision
4 4 of section 364-j of the social services law, as amended by section 14
5 of part C of chapter 58 of the laws of 2004 and as relettered by chapter
6 37 of the laws of 2010, is amended to read as follows:
7 (F) a person eligible for or receiving medical assistance under this
8 article who has established a long term relationship with a health care
9 professional has requested the managed care provider to approve a single
10 patient agreement between the patient and the health care professional,
11 even if the health care professional is not a recurring provider under
12 the person's managed provider network. The health care professional
13 shall be paid the managed care provider's in-network rates. As used in
14 this clause, "long term relationship" means a treatment relationship of
15 ninety days or longer during which the health care professional provided
16 medical assistance to the patient at least ten times. The provisions of
17 this clause shall not apply if there were any reported allegations of
18 fraud, abuse or malpractice from the health care professional that the
19 managed care provider has been made aware of. Such coverage shall be
20 included at the time of application for medical assistance under this
21 article, or, for coverage already in effect, on any anniversary date of
22 the coverage subject to evidence of eligibility for medical assistance
23 under this article. Such coverage may be subject to annual deductibles
24 and co-insurance as may be deemed appropriate by the commissioner of
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD03557-01-3
A. 6465 2
1 health and as are consistent with those established for other benefits
2 for medical assistance under this article; or
3 (G) other services as defined by the commissioner of health.
4 § 3. This act shall take effect on the ninetieth day after it shall
5 have become a law; provided, however, that the amendments to section
6 364-j of the social services law made by section two of this act shall
7 not affect the repeal of such section and shall be deemed repealed ther-
8 ewith.
