Allows dental provider networks, certain health and hospital service corporations, and health care plans to enter into a third-party network contract to provide access to care services and discounted rates of a provider under a provider network contract.
Impact
The enactment of S07919 would significantly impact the landscape of dental care by stipulating that insurers may not cancel or terminate a network provider contract simply because a provider refuses access to a third party. It would require that providers receive complete transparency regarding third-party access, including notifications and obligatory consent from providers for third-party agreements. These provisions aim to bolster provider autonomy while ensuring that patients benefit from expanded access and competitive pricing structures.
Summary
Bill S07919 seeks to amend both the Insurance Law and the Public Health Law in New York to allow dental provider networks, certain health and hospital service corporations, and healthcare plans to enter into third-party network contracts. This legislation aims to enhance patient access to dental care services by facilitating an arrangement where providers can consent to third-party access to their services and discounted rates. This will potentially lead to increased competition and more favorable pricing for services rendered by providers under network contracts.
Contention
Notable points of contention surrounding S07919 include concerns from various stakeholders about the operational complexities that could arise from implementing third-party network contracts. Some opponents of the bill may argue that it could complicate existing provider agreements and pose challenges for smaller providers who may not have the resources to navigate intricate contractual relationships with multiple third-party entities. Furthermore, there are apprehensions regarding the potential for increased administrative burdens on providers and whether these new rules truly lead to better patient outcomes and access to care.
Same As
Allows dental provider networks, certain health and hospital service corporations, and health care plans to enter into a third-party network contract to provide access to care services and discounted rates of a provider under a provider network contract.
Relates to the reimbursement of out-of-network providers of clinical laboratory services by organizations providing or offering comprehensive health services plans.
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.
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.
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.
Provides that no insurance contract or agreement between a health insurance plan and a health care provider, other than a residential health care facility, shall include a provision that: contains a most-favored-nation provision; or restricts the ability of a corporation, an entity that contracts with a corporation for a provider network, or a health care provider to disclose certain costs, prices or information; extends the effective date from January 1, 2023 until July 1, 2023.
Provides that no insurance contract or agreement between a health insurance plan and a health care provider, other than a residential health care facility, shall include a provision that: contains a most-favored-nation provision; or restricts the ability of a corporation, an entity that contracts with a corporation for a provider network, or a health care provider to disclose certain costs, prices or information; extends the effective date from January 1, 2023 until July 1, 2023.
Expanding limitations to third-party access to provider network contracts and discounts unless certain criteria are met and prohibitions on payment method restrictions and limitations on certain transaction fees from dental services to all healthcare services.