Bill > S02449

This bill requires Medicare and Medicaid managed care providers to offer coverage for out-of-network healthcare professionals under specific circumstances. Specifically, if a patient has established a "long-term relationship" with a healthcare professional, defined as receiving treatment for at least 90 days and having at least 10 medical consultations, the patient can request a single patient agreement with that professional, even if they are not part of the managed care provider's network. The out-of-network professional would be reimbursed at the managed care provider's in-network rates. The bill includes an important caveat that this provision does not apply if there are any reported allegations of fraud, abuse, or malpractice against the healthcare professional. The coverage would be implemented at the time of medical assistance application or on the coverage's anniversary date, and may be subject to annual deductibles and co-insurance as determined by the health commissioner. The act will take effect 90 days after becoming law and is titled the "patient choice of health care provider protection act".

Health and Social Services

https://www.nysenate.gov/legislation/bills/2025/S2449