BILL NUMBER: S4526
SPONSOR: BAILEY
 
TITLE OF BILL:
An act to amend the public health law, in relation to expanding health
care plan contract coverage for any health care provider for one hundred
twenty days after the termination of such contract
 
PURPOSE OR GENERAL IDEA OF BILL:
The purpose of this bill, in instances where a contract between a health
plan and a provider is not renewed, is to extend the period of time from
two months to 120 days where a consumer with such health plan may
utilize the services of such provider under the terms of the former
contract. The bill would also provide that coverage during the 120-day
period would extend to all health care entities that are part of the
provider's organization (included in the former contract), not just
hospitals as is currently law.
 
SUMMARY OF SPECIFIC PROVISIONS:
Section one of the bill amends subdivision 5-d of section 4406-c of the
public health law to provide that health plan consumers shall be able to
visit any health care provider under the terms of the forMer contract,
when such contract is not renewed, for a period of 120 days. Existing
law provides that consumers are only permitted to visit hospitals under
the terms of the former contract for a period of 60 days.
 
JUSTIFICATION:
When a massive health insurance company and a health care provider
organization cannot come to an agreement on rates, New Yorkers who
happen to have such insurance should be given ample time to plan for the
change in their health care access. This is especially true in areas
where one provider dominates a region's health care market. Such was
nearly the case in the Bronx where United Healthcare (UHC) and Montef-
iore failed to renew their contract for over seven months, placing thou-
sands in jeopardy of losing access to their primary care doctors and
health care services provided by Montefiore. Ultimately, the two enti-
ties came to a resolution, but the incident highlighted the need to
reexamine existing law on this issue.
Public health law provides for a "cooling off" period of two months in
which individuals are still able to visit a provider hospital under the
terms of the former contract. The UHC/Montefiore dispute, which occurred
over the course of 2021, demonstrated, first, that two months is simply
not enough time given the vital nature of health care coverage, and
second, that only authorizing hospital visits under the former contract,
and not all provider entities (such as primary care doctors), is insuf-
ficient.
Thankfully, there is a baseline in public health law for extending
coverage during such instances, and this bill would build on that foun-
dation to provide more health care security to New Yorkers.
 
PRIOR LEGISLATIVE HISTORY:
2021-22: S7758 - Referred to Health
2022-23: S2189 - Referred to Health
 
FISCAL IMPLICATIONS:
To be determined.
 
EFFECTIVE DATE:
This act shall take effect immediately; provided, however, that the
amendments to subdivision 5-d of section 4406-c of the public health law
made by section one of the act shall not affect the repeal of such
subdivision and shall be deemed repealed therewith.