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Bill > S03231
NY S03231
NY S03231Relates to certain prohibitions in contracts or agreements by health maintenance organizations; prohibits clauses which entitle reimbursement at the lowest price or rate; prohibits contracts which restrict referral of patients based solely upon a health care provider's status with a managed care product; prohibits contracts which allow for the substitution of a pharmaceutical drug or agent by any person other than the prescribing health care professional.
summary
Introduced
01/28/2021
01/28/2021
In Committee
01/05/2022
01/05/2022
Crossed Over
Passed
Dead
12/31/2022
12/31/2022
Introduced Session
2021-2022 General Assembly
Bill Summary
Relates to certain prohibitions in contracts or agreements by health maintenance organizations; prohibits clauses which entitle reimbursement at the lowest price or rate; prohibits contracts which restrict referral of patients based solely upon a health care provider's status with a managed care product; prohibits disclosure of an enrollee's diagnosis on a prescription as a condition for authorizing coverage for payment or dispensing of a prescription; and prohibits contracts which allow for the substitution of a pharmaceutical drug or agent by any person other than the prescribing health care professional.
AI Summary
This bill prohibits certain provisions in contracts or agreements between health maintenance organizations (HMOs) and health care providers. Specifically, it prohibits clauses that allow HMOs to reimburse providers at the lowest price or rate they have charged others, restricts HMOs from prohibiting providers from referring patients based solely on the provider's status with a managed care product, and prohibits HMOs from substituting prescribed pharmaceutical drugs or agents without the prescribing health care professional's approval. The bill also adds similar prohibitions for insurers in their contracts with health care providers.
Committee Categories
Health and Social Services
Sponsors (2)
Last Action
COMMITTED TO RULES (on 06/03/2022)
Official Document
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