Extends period during which health maintenance organization enrollees may continue to receive services from a health care provider who disaffiliates from 60 or 90 days to 1 year, or in case of terminal illness, until the time of such insured's death; bars incentives which induce a provider to provide health care to an enrollee in a manner inconsistent with law.
Summary
Bill A03759 amends the insurance law and public health law in New York to extend the duration for which enrollees in managed care plans can continue receiving services from their current healthcare providers after disaffiliation. Specifically, it extends the transitional period from 60 or 90 days to one year, or until the death of the enrollee in cases of terminal illness. The bill also prohibits health care providers from being incentivized to provide care in a manner inconsistent with the provisions of the law, thereby aiming to protect patient rights and ensure continuity of care during critical health situations.
Impact
The bill significantly impacts state insurance laws by enhancing protections for patients enrolled in managed care plans. It ensures that patients can maintain their ongoing treatment with their healthcare providers for a longer period, which is particularly crucial for individuals with terminal illnesses. This change may lead to a more stable healthcare experience for patients and could influence how managed care organizations structure their provider networks and contracts.
Sentiment
The sentiment surrounding Bill A03759 appears to be generally supportive, as it addresses critical issues of patient rights and continuity of care. However, there may be concerns from insurance providers regarding the potential implications for their operational flexibility and financial responsibilities under the new provisions.
Contention
Notable points of contention may arise from insurance companies who could argue that the extended transitional period and prohibitions on provider incentives may lead to increased costs and administrative burdens. On the other hand, patient advocacy groups and healthcare professionals are likely to support the bill for its focus on patient welfare and rights.
Same As
Extends period during which health maintenance organization enrollees may continue to receive services from a health care provider who disaffiliates from 60 or 90 days to 1 year, or in case of terminal illness, until the time of such insured's death; bars incentives which induce a provider to provide health care to an enrollee in a manner inconsistent with law.
Extends period during which health maintenance organization enrollees may continue to receive services from a health care provider who disaffiliates from 60 or 90 days to 1 year, or in case of terminal illness, until the time of such insured's death; bars incentives which induce a provider to provide health care to an enrollee in a manner inconsistent with law.
Prohibits approved organizations providing coverage under the child health insurance plan from discriminating against health care providers which do not participate in the organization's health care network.
Relating to the form of a claim payment to a health care provider by a health maintenance organization, preferred provider benefit plan, or managed care organization.
Health care providers certain health care provider reimbursement arrangements disclosure to enrollees and health care providers requirement provision, Ombudsperson for public managed health care programs duties modifications, and health carrier liability when a health care provider is limited in providing services by the health carrier
Requires an insurance company which owns a health care provider to pay any health care provider which it does not own an amount that is no less than the amount that it pays a health care provider which it does own for a comparable service; prohibits an insurance company which is owned by a health care provider from paying any health care provider which does not own such insurance company an amount that is less than the amount that it pays a health care provider which does own such company for a comparable service.
Requires an insurance company which owns a health care provider to pay any health care provider which it does not own an amount that is no less than the amount that it pays a health care provider which it does own for a comparable service; prohibits an insurance company which is owned by a health care provider from paying any health care provider which does not own such insurance company an amount that is less than the amount that it pays a health care provider which does own such company for a comparable service.
Allows for a new special open enrollment period to choose a new health insurance plan for consumers in certain instances to allow for continuity of care with an existing health care provider.
Allows for a new special open enrollment period to choose a new health insurance plan for consumers in certain instances to allow for continuity of care with an existing health care provider.