New YorkBill would bar payment cuts tied solely to same-day services
The proposal would limit payment cuts for participating providers when they bill other health services on the same day as covered care.
What it does
Insurers and covered health plans could not lower a participating provider’s negotiated payment for covered evaluation or procedural care solely because the provider billed other health services that day. Administrative-only plans have a narrower duty.
Argument forProviders could receive the negotiated rate for covered evaluation or procedural care when they also bill other services that day, which may make payment more predictable.
Argument againstInsurers could have less flexibility to lower a negotiated payment when a provider bills other covered services on the same day, even if they believe those services justify a reduction.
More detail
Insurers and covered health plans could not lower a provider’s negotiated payment solely because the provider billed other health services on the same day. It covers insurers, health maintenance organizations, and other entities subject to this part of New York insurance law, for participating providers’ evaluation, management, or procedural services. The rule applies only when the services are otherwise covered and the same-day billing is the sole reason for lowering payment. When an insurer or review organization only provides administrative services, its duty is limited to recommending that the third-party payor authorize coverage and payment. The bill would take effect immediately and apply to contracts and policies issued, renewed, changed, or amended on or after that date.
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Where it stands
- Introduced
- Passed 1st Chamber
- Passed 2nd Chamber
- To Governor
- Became Law
Looking ahead
No hearings or votes scheduled.
History
- 2026
- Sep 2REFERRED TO INSURANCEIntroduced
Healthcare