S 10317 NY
Provides for network participation verification and disclosure
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Summary
This bill requires health care providers to verify their network participation status with insurers using real-time verification within 72 hours before representing to patients that they are in-network. Providers must provide written or electronic documentation to patients prior to scheduling or providing non-emergency services that states whether real-time verification was completed and whether the provider is in-network or out-of-network for the patient's specific health plan. If the provider is out-of-network, the documentation must disclose that services will be billed at out-of-network rates and may result in higher out-of-pocket costs. Providers that fail to comply with verification and disclosure requirements are prohibited from billing patients more than the in-network copayment and must accept the in-network allowed amount as payment in full. The bill requires insurers to maintain free, real-time verification systems accessible to providers and to be bound by verifications issued unless obtained through fraud or misrepresentation.
AI-generated plain-language summary of the bill text — neutral, and may be imperfect. See the full text below for the exact wording.
Official abstract
Requires health care providers to verify and disclose their in- or out-of-network status with a prospective patient's health plan.
Sponsor (1)
- Robert Jackson Democratic · primary
Action history (1)
- May 13, 2026 REFERRED TO HEALTH · upper
Text versions (2)
Full text
Full text imported from assembly.state.ny.us
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Bill No.: Summary Actions Committee Votes Floor Votes Memo Text LFIN Chamber Video/Transcript S10317 Summary: BILL NO S10317   SAME AS No Same As   SPONSOR JACKSON   COSPNSR   MLTSPNSR   Add §§25 & 4406-j, Pub Health L; add §§3217-k & 4306-j, Ins L   Requires health care providers to verify and disclose their in- or out-of-network status with a prospective patient's health plan.
Go to top S10317 Text:
STATE OF NEW YORK ________________________________________________________________________
10317
IN SENATE
May 13, 2026 ___________
Introduced by Sen. JACKSON -- read twice and ordered printed, and when printed to be committed to the Committee on Health
AN ACT to amend the public health law and the insurance law, in relation to network participation verification and disclosure
The People of the State of New York, represented in Senate and Assem- bly, do enact as follows:
1 Section 1. Legislative findings and intent. The legislature finds that 2 patients routinely rely on representations by health care providers 3 regarding participation in a health plan's network. Providers frequently 4 state they are "in-network" based on outdated or incomplete information, 5 resulting in unexpected out-of-network charges and financial harm. 6 Existing law requires insurers to maintain accurate provider directories 7 but imposes no corresponding duty on providers to verify their contrac- 8 tual status prior to communicating with patients. This act establishes a 9 clear, enforceable requirement for real-time verification and disclo- 10 sure, and provides consumer protections when such verification does not 11 occur. 12 § 2. The public health law is amended by adding a new section 25 to 13 read as follows: 14 § 25. Network participation verification and disclosure. 1. Defi- 15 nitions. For purposes of this section: 16 (a) "Health care provider" means any individual or entity licensed, 17 certified or authorized to provide health care services in this state. 18 (b) "Insurer" means any insurer, health maintenance organization, or 19 health benefit plan subject to the insurance law or this chapter. 20 (c) "Network participation status" means whether a provider is 21 contracted as a participating provider under a specific health benefit 22 plan. 23 (d) "Real-time verification" means an electronic or telephonic confir- 24 mation obtained directly from the insurer or its designated verification 25 system within the preceding seventy-two hours. 26 2. Verification requirement. No health care provider, or employee or 27 agent thereof shall represent, state, imply or confirm to a patient or 28 prospective patient that the provider is in-network, participating, or
EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD15153-01-6
S. 10317 2
1 otherwise contracted with a health plan unless real-time verification of 2 network participation status has been completed. 3 3. Pre-service documentation and disclosure. (a) Prior to scheduling 4 an appointment or rendering any non-emergency service, a provider shall 5 furnish the patient with written or electronic documentation stating: 6 (i) that real-time verification was completed; and 7 (ii) whether the provider is in-network or out-of-network for the 8 patient's specific health plan. 9 (b) If the provider is out-of-network, the documentation shall state 10 that services will be billed at out-of-network rates and may result in 11 higher out-of-pocket costs. 12 (c) Documentation shall be acknowledged by the patient prior to 13 service. 14 4. Documentation retention. (a) If the patient is billed at the 15 in-network rate or lower, the provider shall not be required to retain 16 or produce proof of real-time verification. 17 (b) If the patient is billed at out-of-network rates, the provider 18 shall retain all verification and disclosure documentation for three 19 years from the date of service. 20 (c) Proof of real-time verification shall be required only when the 21 provider bills out-of-network. 22 5. Penalty for failure to disclose. (a) A provider that fails to 23 comply with subdivisions two or three of this section shall be prohibit- 24 ed from billing, collecting or attempting to collect from the patient 25 any amount other than the in-network copayment applicable under the 26 patient's health plan. 27 (b) Where a claim is made pursuant to paragraph (a) of this subdivi- 28 sion, the insurer shall process the claim as if the provider were 29 in-network, and the provider shall accept the in-network allowed amount 30 as payment in full. 31 (c) Any attempt to bill a patient in violation of this subdivision 32 shall constitute a deceptive business practice under section three 33 hundred forty-nine of the general business law. 34 § 3. The insurance law is amended by adding a new section 3217-k to 35 read as follows: 36 § 3217-k. Verification systems. 1. Every insurer shall maintain a 37 real-time verification system accessible to providers at no cost. 38 2. Insurers shall issue a confirmation number or electronic record for 39 each verification. 40 3. Insurers shall be bound by any verification issued unless obtained 41 through fraud or misrepresentation. 42 § 4. The insurance law is amended by adding a new section 4306-j to 43 read as follows: 44 § 4306-j. Verification systems. 1. Every corporation shall maintain a 45 real-time verification system accessible to providers at no cost. 46 2. Corporations shall issue a confirmation number or electronic record 47 for each verification. 48 3. Corporations shall be bound by any verification issued unless 49 obtained through fraud or misrepresentation. 50 § 5. The public health law is amended by adding a new section 4406-j 51 to read as follows: 52 § 4406-j. Verification systems. 1. Every health maintenance organiza- 53 tion shall maintain a real-time verification system accessible to 54 providers at no cost. 55 2. Health maintenance organizations shall issue a confirmation number 56 or electronic record for each verification.
S. 10317 3
1 3. Health maintenance organizations shall be bound by any verification 2 issued unless obtained through fraud or misrepresentation. 3 § 6. This act shall take effect on the one hundred eightieth day after 4 it shall have become a law. Effective immediately, the addition, amend- 5 ment and/or repeal of any rule or regulation necessary for the implemen- 6 tation of this act on its effective date are authorized to be made and 7 completed on or before such effective date.
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