Bill > A03885

This bill modifies the definition of "health care plan" and the criteria for determining reasonable fees in the independent dispute resolution (IDR) process. The bill expands the definition of health care plan to include additional types of health benefit provisions under civil service law, which broadens the scope of entities that can participate in the IDR process. In terms of fee determination, the bill removes a specific requirement to consider the median rate recognized by health care plans for similar services in the same region. Instead, the bill maintains a more flexible approach that allows independent dispute resolution entities to consider multiple factors when determining appropriate payment, such as the provider's training and experience, usual charges, case complexity, patient characteristics, and the customary cost of physician services. The changes aim to provide more flexibility and nuance in resolving payment disputes between healthcare providers and health plans, ensuring that a wider range of contextual information can be considered during the resolution process.

Business and Industry

https://www.nysenate.gov/legislation/bills/2025/A3885