Assembly Bill A5226

2011-2012 Legislative Session

Restricts limitations on non-affiliated physicians from becoming a network provider of any health care plan or health maintenance organization

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Archive: Last Bill Status - In Assembly Committee

  • Introduced
    • In Committee Assembly
    • In Committee Senate
    • On Floor Calendar Assembly
    • On Floor Calendar Senate
    • Passed Assembly
    • Passed Senate
  • Delivered to Governor
  • Signed By Governor

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2011-A5226 (ACTIVE) - Details

See Senate Version of this Bill:
S7336
Current Committee:
Assembly Insurance
Law Section:
Insurance Law
Laws Affected:
Amd §3217-b, Ins L; amd §4406-c, Pub Health L
Versions Introduced in 2013-2014 Legislative Session:
A67, S4476

2011-A5226 (ACTIVE) - Summary

Provides that no insurer or health care plan shall by contract, written policy or written procedure require the maintenance of hospital privileges by any non-hospital employee health care provider as a condition of entering into or maintaining a contract, agreement of membership or acceptance into a health care plan or health maintenance organization's provider network; provides that no insurer or health care plan can prohibit or restrict any health care provider from referring an insured to another physician based solely upon the referred physician's lack of affiliation and/or lack of hospital privileges.

2011-A5226 (ACTIVE) - Bill Text download pdf 

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  5226

                       2011-2012 Regular Sessions

                          I N  A S S E M B L Y

                            February 14, 2011
                               ___________

Introduced by M. of A. CASTRO -- read once and referred to the Committee
  on Insurance

AN ACT to amend the insurance law and the public health law, in relation
  to  restricting limitations on non-affiliated physicians from becoming
  a network provider of any  health  care  plan  or  health  maintenance
  organization

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Section 3217-b of the insurance law is amended by adding  a
new subsection (j) to read as follows:
  (J)  (1) NO INSURER SUBJECT TO THIS ARTICLE SHALL BY CONTRACT, WRITTEN
POLICY OR WRITTEN PROCEDURE REQUIRE THE AFFILIATION AND/OR  REQUIRE  THE
MAINTENANCE  OF  HOSPITAL PRIVILEGES BY ANY NON-HOSPITAL EMPLOYEE HEALTH
CARE PROVIDER AS A CONDITION  OF  ENTERING  INTO  AND/OR  MAINTAINING  A
CONTRACT,  AGREEMENT OF MEMBERSHIP OR ACCEPTANCE INTO A HEALTH CARE PLAN
OR HEALTH MAINTENANCE ORGANIZATION'S PROVIDER NETWORK.
  (2) NO INSURER SUBJECT TO THIS  ARTICLE  SHALL  BY  CONTRACT,  WRITTEN
POLICY OR WRITTEN PROCEDURE PROHIBIT OR RESTRICT ANY HEALTH CARE PROVID-
ER  FROM REFERRING AN INSURED TO ANOTHER PHYSICIAN BASED SOLELY UPON THE
REFERRED PHYSICIAN'S LACK OF AFFILIATION AND/OR LACK OF HOSPITAL  PRIVI-
LEGES;  PROVIDED  THAT  THE  REFERRED  PHYSICIAN IS LICENSED TO PRACTICE
UNDER APPLICABLE STATE LAW.
  S 2. Subdivision 7 of section 4406-c of  the  public  health  law,  as
renumbered by section 487 of the laws of 2010, is renumbered subdivision
9 and a new subdivision 8 is added to read as follows:
  8.  (A) NO HEALTH CARE PLAN SHALL BY CONTRACT, WRITTEN POLICY OR WRIT-
TEN PROCEDURE REQUIRE THE AFFILIATION AND/OR REQUIRE THE MAINTENANCE  OF
HOSPITAL PRIVILEGES BY ANY NON-HOSPITAL EMPLOYEE HEALTH CARE PROVIDER AS
A CONDITION OF ENTERING INTO AND/OR MAINTAINING A CONTRACT, AGREEMENT OF
MEMBERSHIP  OR  ACCEPTANCE INTO A HEALTH CARE PLAN OR HEALTH MAINTENANCE
ORGANIZATION'S PROVIDER NETWORK.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD05247-01-1

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