STATE OF NEW YORK ________________________________________________________________________ 6650 2025-2026 Regular Sessions IN ASSEMBLY March 6, 2025 ___________ Introduced by M. of A. WEPRIN -- read once and referred to the Committee on Insurance AN ACT to amend the insurance law and the public health law, in relation to third-party network contracts The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. The insurance law is amended by adding a new section 3217-k 2 to read as follows: 3 § 3217-k. Leased dental networks. (a) The following provisions shall 4 apply to dental provider networks: 5 (1) An insurer of dental care and services may enter into a third-par- 6 ty network contract to provide access to care services and discounted 7 rates of a provider under a provider network contract if: 8 (A) the provider in the network consents to allow the third party to 9 access the provider's services and discounted rates at the time the 10 original contract is entered into or renewed and whenever there is a 11 material modification to the third-party network contract; 12 (B) the insurer allows the provider to contract directly with the 13 third party instead of allowing the third party to access the provider's 14 services and discounted rates; and 15 (C) the third-party network contract obligates the third party to 16 comply with all applicable terms, limitations and conditions of the 17 provider network contract. 18 (2) An insurer of dental care and services may not cancel or otherwise 19 terminate a network provider contract with a provider on the grounds 20 that the provider refuses to allow access by a third party to the 21 provider's services and discounted rates. 22 (3) An insurer of dental care and services that contracts with a third 23 party to provide access to the services and discounted rates of a 24 provider under a provider network contract shall: EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD10275-01-5
A. 6650 2 1 (A) at the time a provider network contract is entered into, renewed 2 or extended, give to the provider, in writing and electronically, a list 3 of all third parties known by the insurer to which the insurer has or 4 will provide access to the services and discounted rates of the provider 5 under the provider network contract; 6 (B) maintain a website through which the provider may obtain a list, 7 updated at least every ninety days, of all third parties that have 8 access to the provider's care services and discounted rates under the 9 provider network contract; 10 (C) require a third party to identify on each remittance or explana- 11 tion of payment sent to a provider the source of any contractual 12 discount in rates taken by the third party under the provider network 13 contract; 14 (D) notify the provider no less than thirty days prior to the effec- 15 tive date of a new third-party network contract; 16 (E) notify each third party described under subparagraphs (A) and (B) 17 of this paragraph of the termination of the provider network contract no 18 later than ninety days prior to the effective date of such termination; 19 (F) make available to a provider within thirty days of the provider's 20 request a copy of the provider network contract currently in force that 21 was relied upon by the insurer in the adjudication of the provider's 22 claim; and 23 (G) secure the consent of the provider to any changes or new third 24 party agreement within thirty days of notification pursuant to subpara- 25 graph (D) of this paragraph. 26 (b) The notice required under subparagraphs (D) and (E) of paragraph 27 three of subsection (a) of this section shall be provided by any reason- 28 able means, including but not limited to written notice, electronic 29 communication or an update to an electronic database. 30 (c) Subject to any applicable continuity of care requirements, agree- 31 ments or contractual provisions, a third party's right to access a 32 provider's services and discounted rates under a provider network 33 contract shall terminate on the date the provider network contract is 34 terminated. 35 (d) No policy or contract issued, renewed, modified, altered or 36 amended after the effective date of this section shall contain 37 provisions allowing for waiver of the notice requirements contained in 38 this section. 39 (e) For purposes of this section, the following terms shall have the 40 following meanings: 41 (1) "Provider" shall mean a dentist or group of dentists licensed 42 pursuant to article one hundred thirty-three of the education law. 43 (2) "Consent" shall mean a written consent signed by the provider. 44 (3) "Material modification" shall mean changes to the terms or condi- 45 tions of a contract that alter reimbursement rates paid to providers, 46 fee schedules for providers, or benefits or covered procedures under a 47 plan for which a provider is a network provider but shall not include 48 adding a new third party to an existing third-party network contract 49 without any material modification to the third-party network contract. 50 (4) "Provider network contract" shall mean a contract entered into 51 between a provider and insurer of dental care and services for the 52 provision of services to enrollees in plans offered by the insurer. 53 (5) "Third party" shall mean an entity, including but not limited to a 54 payer, dental benefits administrator or a dental network leasing compa- 55 ny, that enters into a third-party network contract with an insurer of 56 dental care and services.
A. 6650 3 1 (6) "Third-party network contract" shall mean a contract entered into 2 between an insurer and a third party insurer of dental care and services 3 to gain access to services and discounted rates of a provider under the 4 original provider network contract with the provider. 5 § 2. The insurance law is amended by adding a new section 4242 to read 6 as follows: 7 § 4242. Network leasing. (a) An insurer of dental care and services 8 may enter into a third-party network contract to provide access to care 9 services and discounted rates of a provider under a provider network 10 contract if: 11 (1) the provider in the network consents to allow the third party to 12 access the provider's services and discounted rates at the time the 13 original contract is entered into or renewed and whenever there is a 14 material modification to the third-party network contract; 15 (2) the insurer allows the provider to contract directly with the 16 third party instead of allowing the third party to access the provider's 17 services and discounted rates; and 18 (3) the third-party network contract obligates the third party to 19 comply with all applicable terms, limitations and conditions of the 20 provider network contract. 21 (b) An insurer of dental care and services may not cancel or otherwise 22 terminate a network provider contract with a provider on the grounds 23 that the provider refuses to allow access by a third party to the 24 provider's services and discounted rates. 25 (c) An insurer of dental care and services that contracts with a third 26 party to provide access to the services and discounted rates of a 27 provider under a provider network contract shall: 28 (1) at the time a provider network contract is entered into, renewed 29 or extended, give to the provider, in writing and electronically, a list 30 of all third parties known by the insurer to which the insurer has or 31 will provide access to the services and discounted rates of the provider 32 under the provider network contract; 33 (2) maintain a website through which the provider may obtain a list, 34 updated at least every ninety days, of all third parties that have 35 access to the provider's care services and discounted rates under the 36 provider network contract; 37 (3) require a third party to identify on each remittance or explana- 38 tion of payment sent to a provider the source of any contractual 39 discount in rates taken by the third party under the provider network 40 contract; 41 (4) notify the provider no less than thirty days prior to the effec- 42 tive date of a new third-party network contract; 43 (5) notify each third party described under paragraphs one and two of 44 this subsection of the termination of the provider network contract no 45 later than ninety days prior to the effective date of such termination; 46 (6) make available to a provider within thirty days of the provider's 47 request a copy of the provider network contract currently in force that 48 was relied upon by the insurer in the adjudication of the provider's 49 claim; and 50 (7) secure the consent of the provider to any changes or new third 51 party agreement within thirty days of notification pursuant to paragraph 52 four of this subsection. 53 (d) The notice required under paragraphs four and five of subsection 54 (c) of this section shall be provided by any reasonable means, including 55 but not limited to written notice, electronic communication or an update 56 to an electronic database.
A. 6650 4 1 (e) Subject to any applicable continuity of care requirements, agree- 2 ments or contractual provisions, a third party's right to access a 3 provider's services and discounted rates under a provider network 4 contract shall terminate on the date the provider network contract is 5 terminated. 6 (f) No policy or contract issued, renewed, modified, altered or 7 amended after the effective date of this section shall contain 8 provisions allowing for waiver of the notice requirements contained in 9 this section. 10 (g) For purposes of this section, the following terms shall have the 11 following meanings: 12 (1) "Provider" shall mean a dentist or group of dentists licensed 13 pursuant to article one hundred thirty-three of the education law. 14 (2) "Consent" shall mean a written consent signed by the provider. 15 (3) "Material modification" shall mean changes to the terms or condi- 16 tions of a contract that alter reimbursement rates paid to providers, 17 fee schedules for providers, or benefits or covered procedures under a 18 plan for which a provider is a network provider but shall not include 19 adding a new third party to an existing third-party network contract 20 without any material modification to the third-party network contract. 21 (4) "Provider network contract" shall mean a contract entered into 22 between a provider and insurer of dental care and services for the 23 provision of services to enrollees in plans offered by the insurer. 24 (5) "Third party" shall mean an entity, including but not limited to a 25 payer, dental benefits administrator or a dental network leasing compa- 26 ny, that enters into a third-party network contract with an insurer of 27 dental care and services. 28 (6) "Third-party network contract" shall mean a contract entered into 29 between an insurer and a third party insurer of dental care and services 30 to gain access to services and discounted rates of a provider under the 31 original provider network contract with the provider. 32 § 3. The insurance law is amended by adding a new section 4325-a to 33 read as follows: 34 § 4325-a. Leased networks. (a) A corporation organized under this 35 title: 36 (1) may enter into a third-party network contract to provide access to 37 care services and discounted rates of a provider under a provider 38 network contract if: 39 (A) the provider in the network consents to allow the third party to 40 access the provider's services and discounted rates at the time the 41 original contract is entered into or renewed and whenever there is a 42 material modification to the third-party network contract; 43 (B) the corporation allows the provider to contract directly with the 44 third party instead of allowing the third party to access the provider's 45 services and discounted rates; and 46 (C) the third-party network contract obligates the third party to 47 comply with all applicable terms, limitations and conditions of the 48 provider network contract; 49 (2) may not cancel or otherwise terminate a network provider contract 50 with a provider on the grounds that the provider refuses to allow access 51 by a third party to the provider's services and discounted rates; 52 (3) where the corporation contracts with a third party to provide 53 access to the services and discounted rates of a provider under a 54 provider network contract, shall: 55 (A) at the time a provider network contract is entered into, renewed 56 or extended, give to the provider, in writing and electronically, a list
A. 6650 5 1 of all third parties known by the corporation to which the insurer has 2 or will provide access to the services and discounted rates of the 3 provider under the provider network contract; 4 (B) maintain a website through which the provider may obtain a list, 5 updated at least every ninety days, of all third parties that have 6 access to the provider's care services and discounted rates under the 7 provider network contract; 8 (C) require a third party to identify on each remittance or explana- 9 tion of payment sent to a provider the source of any contractual 10 discount in rates taken by the third party under the provider network 11 contract; 12 (D) notify the provider no less than thirty days prior to the effec- 13 tive date of a new third-party network contract; 14 (E) notify each third party described under subparagraphs (A) and (B) 15 of this paragraph of the termination of the provider network contract no 16 later than ninety days prior to the effective date of such termination; 17 (F) make available to a provider within thirty days of the provider's 18 request a copy of the provider network contract currently in force that 19 was relied upon by the corporation in the adjudication of the provider's 20 claim; and 21 (G) secure the consent of the provider to any changes or new third- 22 party agreement within thirty days of notification pursuant to subpara- 23 graph (D) of this paragraph; 24 (4) provide the notice required under subparagraphs (D) and (E) of 25 paragraph three of this subsection by any reasonable means, including 26 but not limited to written notice, electronic communication or an update 27 to an electronic database; 28 (5) subject to any applicable continuity of care requirements, agree- 29 ments or contractual provisions, shall ensure a third party's right to 30 access a provider's services and discounted rates under a provider 31 network contract will terminate on the date the provider network 32 contract is terminated; and 33 (6) shall not issue, renew, modify, alter or amend any policy or 34 contract after the effective date of this section to contain provisions 35 allowing for waiver of the notice requirements contained in this 36 section. 37 (b) For purposes of this section, the following terms shall have the 38 following meanings: 39 (1) "Provider" shall mean a dentist or group of dentists licensed 40 pursuant to article one hundred thirty-three of the education law. 41 (2) "Consent" shall mean a written consent signed by the provider. 42 (3) "Material modification" shall mean changes to the terms or condi- 43 tions of a contract that alter reimbursement rates paid to providers, 44 fee schedules for providers, or benefits or covered procedures under a 45 plan for which a provider is a network provider but shall not include 46 adding a new third party to an existing third-party network contract 47 without any material modification to the third-party network contract. 48 (4) "Provider network contract" shall mean a contract entered into 49 between a provider and insurer of dental care and services for the 50 provision of services to enrollees in plans offered by the insurer. 51 (5) "Third party" shall mean an entity, including but not limited to a 52 payer, dental benefits administrator or a dental network leasing compa- 53 ny, that enters into a third-party network contract with an insurer of 54 dental care and services. 55 (6) "Third-party network contract" shall mean a contract entered into 56 between an insurer and a third party insurer of dental care and services
A. 6650 6 1 to gain access to services and discounted rates of a provider under the 2 original provider network contract with the provider. 3 § 4. The public health law is amended by adding a new section 4406-j 4 to read as follows: 5 § 4406-j. Leased networks. 1. A health care plan: 6 (a) may enter into a third-party network contract to provide access to 7 care services and discounted rates of a provider under a provider 8 network contract if: 9 (i) the provider in the network consents to allow the third party to 10 access the provider's services and discounted rates at the time the 11 original contract is entered into or renewed and whenever there is a 12 material modification to the third-party network contract; 13 (ii) the health care plan allows the provider to contract directly 14 with the third party instead of allowing the third party to access the 15 provider's services and discounted rates; and 16 (iii) the third-party network contract obligates the third party to 17 comply with all applicable terms, limitations and conditions of the 18 provider network contract; 19 (b) may not cancel or otherwise terminate a network provider contract 20 with a provider on the grounds that the provider refuses to allow access 21 by a third party to the provider's services and discounted rates; 22 (c) where the health care plan contracts with a third party to provide 23 access to the services and discounted rates of a provider under a 24 provider network contract, shall: 25 (i) at the time a provider network contract is entered into, renewed 26 or extended, give to the provider, in writing and electronically, a list 27 of all third parties known by the health care plan to which the insurer 28 has or will provide access to the services and discounted rates of the 29 provider under the provider network contract; 30 (ii) maintain a website through which the provider may obtain a list, 31 updated at least every ninety days, of all third parties that have 32 access to the provider's care services and discounted rates under the 33 provider network contract; 34 (iii) require a third party to identify on each remittance or explana- 35 tion of payment sent to a provider the source of any contractual 36 discount in rates taken by the third party under the provider network 37 contract; 38 (iv) notify the provider no less than thirty days prior to the effec- 39 tive date of a new third-party network contract; 40 (v) notify each third party described under subparagraphs (i) and (ii) 41 of this paragraph of the termination of the provider network contract no 42 later than ninety days prior to the effective date of such termination; 43 (vi) make available to a provider within thirty days of the provider's 44 request a copy of the provider network contract currently in force that 45 was relied upon by the health care plan in the adjudication of the 46 provider's claim; and 47 (vii) secure the consent of the provider to any changes or new third 48 party agreement within thirty days of notification pursuant to subpara- 49 graph (iv) of this paragraph; 50 (d) shall provide the notice required under subparagraphs (iv) and (v) 51 of paragraph (c) of this subdivision by any reasonable means, including 52 but not limited to written notice, electronic communication or an update 53 to an electronic database; 54 (e) subject to any applicable continuity of care requirements, agree- 55 ments or contractual provisions, shall ensure that a third party's right 56 to access a provider's services and discounted rates under a provider
A. 6650 7 1 network contract will terminate on the date the provider network 2 contract is terminated; and 3 (f) shall not issue, renew, modify, alter or amend any policy or 4 contract after the effective date of this section to contain provisions 5 allowing for waiver of the notice requirements contained in this 6 section. 7 2. For purposes of this section, the following terms shall have the 8 following meanings: 9 (a) "Provider" shall mean a dentist or group of dentists licensed 10 pursuant to article one hundred thirty-three of the education law. 11 (b) "Consent" shall mean a written consent signed by the provider. 12 (c) "Material modification" shall mean changes to the terms or condi- 13 tions of a contract that alter reimbursement rates paid to providers, 14 fee schedules for providers, or benefits or covered procedures under a 15 plan for which a provider is a network provider but shall not include 16 adding a new third party to an existing third-party network contract 17 without any material modification to the third-party network contract. 18 (d) "Provider network contract" shall mean a contract entered into 19 between a provider and insurer of dental care and services for the 20 provision of services to enrollees in plans offered by the insurer. 21 (e) "Third party" shall mean an entity, including but not limited to a 22 payer, dental benefits administrator or a dental network leasing compa- 23 ny, that enters into a third-party network contract with an insurer of 24 dental care and services. 25 (f) "Third-party network contract" shall mean a contract entered into 26 between an insurer and a third party insurer of dental care and services 27 to gain access to services and discounted rates of a provider under the 28 original provider network contract with the provider. 29 (g) "Health care plan" shall mean a health maintenance organization 30 licensed pursuant to article forty-three of the insurance law or certi- 31 fied pursuant to this article or an independent practice association 32 certified or recognized pursuant to this article or a medical group. 33 § 5. This act shall take effect immediately and shall apply to poli- 34 cies and contracts issued, renewed, amended, modified or altered on or 35 after such date.