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.
Summary
S10219 would amend New York’s insurance law to create a payment-parity rule for transactions between vertically integrated insurers and health care providers. If an insurance company owns a provider, it would be required to pay outside providers at least as much as it pays its owned providers for comparable services. The bill also applies the reverse rule when an insurance company is owned by a health care provider, prohibiting that insurer from paying non-owner providers less than owner-affiliated providers for comparable services.
The measure is aimed at preventing preferential reimbursement arrangements that could disadvantage independent providers and distort competition in the health care market. It would take effect 60 days after becoming law and would add a new subsection to Insurance Law section 3224-a, which governs prompt payment and related insurer payment practices.
Impact
The bill would directly affect insurer reimbursement practices in New York by imposing a statutory nondiscrimination requirement tied to ownership relationships between insurers and providers. It would not broadly change coverage mandates or benefit design, but it would regulate how insurers set payment amounts for comparable services when ownership ties exist. Independent physicians, hospitals, clinics, and other health care providers could see higher or more equalized reimbursement rates if they are currently paid less than affiliated entities.
Sentiment
No committee transcript or vote record is available, so there is no documented debate or recorded legislative sentiment in the provided materials. Based on the bill’s structure, it appears to reflect a policy concern about fairness and market competition in provider reimbursement, with the sponsor seeking to limit preferential treatment for affiliated entities. The absence of recorded opposition or support in the available history means the overall sentiment cannot be assessed beyond the bill’s stated purpose.
Contention
The main point of contention is likely to be whether the state should intervene in insurer-provider contracting to equalize payments across affiliated and non-affiliated providers. Supporters would likely frame the bill as protecting independent providers and promoting transparency and competition, while opponents may argue it restricts contracting flexibility, could raise costs, and may interfere with integrated care models or value-based arrangements. Because no hearing transcript or vote is provided, the specific positions of legislators, insurers, or provider groups are not documented here.
Same As
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.
Enacts the "health insurance preauthorization disclosure act"; requires health insurance companies to provide participating health care providers with a list of health care treatments and services that require preauthorization from the health insurance company.
Provides that it is unlawful for any person to directly or indirectly own, operate, or control the whole or any part of a health insurance company and a health care provider; requires divestment within three years.
Provides that it is unlawful for any person to directly or indirectly own, operate, or control the whole or any part of a health insurance company and a health care provider; requires divestment within three years.
Prohibits insurance companies from paying a rate that is less than the approved Medicaid rate set by the executive office of health and human services.
Prohibits insurance companies from paying a rate that is less than the approved Medicaid rate set by the executive office of health and human services.
Prohibits insurance companies from paying a rate that is less than the approved Medicaid rate set by the executive office of health and human services.
Prohibits insurance companies from paying a rate that is less than the approved Medicaid rate set by the executive office of health and human services.
Enacts the "health insurance preauthorization disclosure act"; requires health insurance companies to provide participating health care providers with a list of health care treatments and services that require preauthorization from the health insurance company.
Enacts the "health insurance preauthorization disclosure act"; requires health insurance companies to provide participating health care providers with a list of health care treatments and services that require preauthorization from the health insurance company.