Bill > A02140

This bill addresses fair pricing for low-complexity, routine medical care by establishing a site-neutral payment policy for certain medical services. The legislation requires health care providers who participate in health benefit plans to accept payment rates that do not exceed 150% of Medicare rates for applicable services, which include specific outpatient and ambulatory items like certain office visits and evaluation and management services. The bill defines key terms such as "health care provider," "health benefit plan," and "applicable services," and mandates that providers cannot charge facility fees for these services. Additionally, the bill requires health insurance carriers and the state department to collect and publish data on service pricing, with annual reporting to state leadership. The legislation includes enforcement mechanisms, such as administrative penalties for non-compliance, with health care providers potentially facing fines of $1,000 per improper claim or $100,000 per contract occurrence. The bill aims to reduce healthcare costs by standardizing payment rates across different ambulatory care settings and promoting transparency in medical service pricing.

Health and Social Services

https://www.nysenate.gov/legislation/bills/2025/A2140