New York Gov. David Paterson recently signed three health care bills that are aimed at reforming managed care and expanding COBRA coverage.
The managed care bill (A. 8402) is a comprehensive reform bill. The bill prohibits health plans from treating in-network providers as out-of-network because the referring provider was out-of-network. The majority of the bill takes effect January 1, 2010, with some provisions having varying effective dates. Effective immediately, however, the bill requires health plans to notify providers before making any adverse reimbursement changes to provider contracts and allows the provider to terminate the contract within 30 days of this notice. The bill also shortens the payment timeframe to providers from 45 days to 30 days for electronically submitted claims; prohibits health plans from denying payments due to coordination of benefits, unless there is a reasonable basis to believe an insured has other coverage; allows for provisional cre dentialing of new health care professionals; extends the requirements currently applicable to health maintenance organizations regarding grievance procedures and access to care to preferred provider organizations, exclusive provider organizations and HMO look-alike plans; establishes a new external appeal standard for rare diseases; and reduces the time health plans have to review a request for post-hospital home health care.
The "mini-Cobra" bill (A. 8400) extends the continuation of coverage from 18 to 36 months. The bill covers employers that have less than 20 employees and will affect all contracts issued, renewed, modified, altered or amended on or after July 1, 2009. The third bill (A. 9038), effective September 1, 2009, requires health plans to offer an option to continue coverage for unmarried young adults through age 29 under a parent's health insurance policy.