Bill > A06803

This bill establishes a demonstration program allowing health care providers in specific New York counties (Albany, Columbia, Greene, Orange, and others) to collectively negotiate certain contract terms with health care plans that have a substantial market share. The bill enables health care providers to negotiate non-fee related terms such as utilization review procedures, coverage provisions, clinical guidelines, and administrative processes, as well as fee-related terms like service fees and reimbursement methodologies when a health care plan has significant market dominance. The negotiations must be conducted through a designated health care providers' representative who must file detailed reports with the commissioner of health and obtain approval before and after negotiations. The bill includes strict requirements to prevent anti-competitive practices, such as limiting the market representation of the providers' representative and prohibiting actions that would exclude or limit provider participation. The legislation is intended to address power imbalances between health care providers and health plans, with the goal of improving healthcare consumer outcomes. The demonstration program will be reviewed through a comprehensive report to be submitted to state leadership before the act's expiration three years after implementation, which will assess the program's impact on care quality, access, and healthcare costs.

Health and Social Services

https://www.nysenate.gov/legislation/bills/2025/A6803