•  Summary 
  •  Actions 
  •  Committee Votes 
  •  Floor Votes 
  •  Memo 
  •  Text 
  •  LFIN 
  •  Chamber Video/Transcript 

A06465 Summary:

Amd §364-j, Soc Serv L
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.
Go to top

A06465 Text:

                STATE OF NEW YORK
                               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.

        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.
Go to top