Requires Medicare and Medicaid managed care providers to provide coverage for certain out-of-network health care when the patient has a long term relationship with a medical professional who is not a recurring provider under the managed care provider's network.
Summary
S02449, titled the “patient choice of health care provider protection act,” would require Medicare and Medicaid managed care providers to cover certain out-of-network care when a patient has an established long-term relationship with a health care professional who is not in the managed care network. The bill focuses on patients receiving medical assistance under the Social Services Law and creates a pathway for a single-patient agreement so that the patient can continue seeing that provider while the provider is paid at the managed care plan’s in-network rate.
To qualify, the patient must have had a treatment relationship of at least 90 days during which the provider delivered care at least 10 times. The bill excludes cases where the provider is known to have reported allegations of fraud, abuse, or malpractice. Coverage would be available when applying for medical assistance or, for existing coverage, on an anniversary date, and could be subject to deductibles and coinsurance set by the commissioner of health consistent with other medical assistance benefits.
Impact
The bill would amend section 364-j of the Social Services Law to expand managed care coverage obligations for Medicaid-related medical assistance, and by its caption, it also seeks to affect Medicare and Medicaid managed care arrangements for out-of-network services. It would create a statutory right for eligible patients to request continuity of care with a non-network provider under specified conditions, while requiring payment at in-network rates and allowing the Department of Health to apply cost-sharing rules. The measure would affect managed care organizations, patients with ongoing provider relationships, and out-of-network clinicians who may be able to continue treating covered patients under single-patient agreements.
Sentiment
The available record shows the bill was introduced and referred to the Senate Health Committee, but there are no recorded committee transcripts or votes in the provided materials. Based on the bill text and caption, the measure appears designed to support patient continuity and provider choice, suggesting a generally consumer- and patient-friendly policy approach. Because no debate or voting history is provided, there is no documented opposition or support to characterize beyond the bill’s stated purpose.
Contention
The main policy tension is between patient continuity of care and managed care network controls. Supporters would likely favor allowing patients with established relationships to keep seeing trusted providers, especially for ongoing treatment, while managed care plans may view the bill as limiting network management and potentially increasing costs. The bill also draws a line against providers with allegations of fraud, abuse, or malpractice, which may reduce concern about inappropriate use, but the lack of committee discussion means no specific objections or amendments are documented in the provided record.
Same As
Requires Medicare and Medicaid managed care providers to provide coverage for certain out-of-network health care when the patient has a long term relationship with a medical professional who is not a recurring provider under the managed care provider's network.
Requires Medicare and Medicaid managed care providers to provide coverage for certain out-of-network health care when the patient has a long term relationship with a medical professional who is not a recurring provider under the managed care provider's network.
Requires Medicare and Medicaid managed care providers to provide coverage for certain out-of-network health care when the patient has a long term relationship with a medical professional who is not a recurring provider under the managed care provider's network.
Ensures Medicaid spending results in real access to medical care by increasing transparency in Medicaid managed care network adequacy reviews and safeguarding continuity of care in light of recent major provider network withdrawals.
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