December 7, 2022
This morning the NYS Council hosted Part One of our Contracting with Payers training with Adam Falcone. We are so pleased so many NYS Council member agency reps prioritized this event! Part Two is coming up on December 14 from 9-12. We will send a link to the event to the contact person in your agency who registered your staff on Monday, Dec. 12 at 10:00 a.m.
For those who may have missed the training this morning, we have posted the audio recording along with the Power Point slide deck, on our website in the section called ‘Events’ and specifically, under the tab labeled ‘Archived Events’. You will need a User Name and Password to access this part of our website. If you need credentials, please send an email to cindy@nyscouncil.org and request a User Name and Password. Cindy will expedite asap.
(1) The following rule makings were published in today’s State Register by the Office of Children & Family Services which we thought may be of interest to NYS Council members:
(2) The following Emergency Rule Makings were published in today’s State Register by NYSDOH which we thought would of particular interest to hospital members of the NYS Council:
(3) The following Notice of Adoption was published in today’s State Register by DFS related to Minimum Standards for Health Insurance:
- To apply disclosure requirements to dental and vision insurance, and hold issuers responsible for inaccurate network status information. Please see below language from the adopted rule regarding the inaccurate network information provisions.
From DFS Rule:(3) This subdivision shall apply to any policies issued, renewed, modified, or amended on or after one year after the effective date of this section.
A new section 52.77 is added as follows:
§ 52.77 Payment when an issuer provides inaccurate network status information.
(a) If an insured who is covered under an accident and health insurance policy that uses a network of health care providers receives a bill for out-of-network services resulting from an issuer providing inaccurate network status information (as defined below) to an insured, the issuer shall not impose on the insured
a copayment, coinsurance, or deductible for the service that is greater than the copayment, coinsurance, or deductible that would be owed if the insured had received services from a participating provider. The issuer shall apply the out-of-pocket maximum that would have applied had the services been received from a participating provider.
(b) Pursuant to Insurance Law sections 3217-b(n) and 4325(o) and Public Health Law section 4406-c(12), if an issuer provides inaccurate network status information (as defined below) to an insured, the issuer shall reimburse the provider for the out-of-network services regardless of whether the insured’s coverage includes out-of-network services.
(c)(1) An issuer that issues comprehensive health insurance policies shall provide network status information to an insured in writing through print or electronic means, if the insured consents to electronic communication, within one business day of the insured requesting the information by telephone or through electronic means, if available.
(2) An issuer that issues a policy, other than a comprehensive health insurance policy, that uses a network of providers shall provide network status information to an insured in writing through print or electronic means, if the insured consents to electronic communication, within three business days of the insured requesting the information by telephone or through electronic means, if available.
(3) An issuer shall retain any recordings of telephone requests for network status information and a copy of its written response to the insured in the insured’s file in accordance with section 243.2(b)(8) of this Part.
(d) An issuer provides inaccurate network status information when:
(1) the issuer represents in the provider directory posted on its website that a non-participating provider is participating in the issuer’s network;
(2) the issuer provides information, upon an insured’s request made by telephone or through electronic means, if available, that a nonparticipating provider is participating in the issuer’s network;
(3) the issuer fails to provide information in writing through print or electronic means, if the insured consents to electronic communication, regarding a specific provider’s participating status within the timeframes
established in subdivision (c) of this section; or
(4) the issuer represents in the hard copy provider directory that a provider is participating in the issuer’s network and the provider is nonparticipating as of the date of publication of the hard copy provider directory.
(e) An issuer shall include in its hard copy provider directory a notification that the information contained in the directory was accurate as of the date of publication of such directory and that an insured should consult the provider directory posted on the issuer’s website to obtain the most current provider directory information.
(f) As used in this section:
(1) Non-participating means not having an agreement with an issuer with respect to the rendering of health care services to an insured.
(2) Participating means having an agreement with an issuer with respect to the rendering of health care services to an insured.
(3) Issuer means an insurer licensed to write accident and health insurance in this State, a corporation organized pursuant to Insurance Law Article 43, a municipal cooperative health benefit plan certified pursuant to Insurance Law Article 47, a health maintenance organization certified pursuant to Public Health Law Article 44, and a student health plan certified pursuant to Insurance Law section 1124.
(g) This section shall apply to all comprehensive health insurance policies issued, renewed, modified, or amended on or after the effective date of this section. This section shall apply to policies other than comprehensive health insurance policies that are issued, renewed, modified, or amended on or after one year after the effective date of this section.
For more information: https://dos.ny.gov/system/files/documents/2022/12/120722.pdf
Please let us know if you have any question