Authorizes the imposition of penalties on subcontractors for failure to adhere to the standards for prompt, fair and equitable settlement of claims for health care and payments for health care services.
Summary
S05323 amends New York’s insurance law governing prompt payment of health care claims. Under current law, insurers and related organizations that fail to timely and properly process health care claims can be required to pay the claim amount plus interest. This bill would extend enforcement by authorizing the superintendent to impose penalties directly on subcontractors of an insurer or other covered organization when the subcontractor is reasonably shown to have caused the violation.
The bill also gives the superintendent authority to double the penalties already available under the insurance law when an insurer, organization, or corporation is shown to have engaged in a pattern of failing to comply with the prompt, fair, and equitable claims settlement standards. The measure applies to health care claims submitted on or after the effective date, which is 90 days after enactment, and authorizes any needed implementing regulations to be adopted immediately.
Impact
The bill would amend Insurance Law section 3224-a to broaden liability for delayed or improper payment of health care claims by reaching subcontractors involved in claims processing, not just the insurer or primary organization. It would also strengthen the enforcement toolkit of the superintendent by allowing enhanced, doubled penalties for repeated noncompliance patterns. Health care providers and claim submitters could benefit from additional pressure on claims administrators to pay promptly, while insurers, managed care organizations, and their vendors could face greater financial exposure and compliance obligations.
Sentiment
The available record shows no committee transcript or vote data, so there is no documented floor or committee debate to gauge support or opposition. Based on the bill’s text and caption, the measure appears aimed at strengthening consumer- and provider-protection enforcement in the health care claims process, which typically suggests a pro-provider, pro-enforcement posture. No recorded votes or amendments are available in the provided materials.
Contention
The main point of potential contention is the expansion of penalties beyond insurers to subcontractors, which could be viewed by insurers and claims-processing vendors as increasing liability for entities further removed from the underlying claim decision. Another possible issue is the bill’s authorization for doubled penalties in cases of a demonstrated pattern of noncompliance, which may raise concerns about administrative discretion and the severity of sanctions. On the other hand, health care providers are likely to support the measure because it creates stronger incentives for timely payment and accountability across the claims-processing chain.
Same As
Authorizes the imposition of penalties on subcontractors for failure to adhere to the standards for prompt, fair and equitable settlement of claims for health care and payments for health care services.
Authorizes the imposition of penalties on subcontractors for failure to adhere to the standards for prompt, fair and equitable settlement of claims for health care and payments for health care services.
A bill for an act relating to health carriers and payment of claims, audits, and standards of conduct; prior authorizations and utilization review organizations; and providing civil penalties and including applicability provisions.(See HF 2635.)
To Prohibit Healthcare Insurers From Exercising Recoupment For Payment Of Healthcare Services More Than One Year After The Payment For Healthcare Services Was Made.
Relating to the calculation of penalties for violating certain laws governing the prompt payment of claims submitted by a physician or health care provider to certain health benefit plan issuers.
Relating to the submission, payment, and audit of certain claims for and utilization review of health services, including services provided under the Medicaid managed care and child health plan programs.