The 2009 Managed Care Reform Act: Does It Go Far Enough?

In this era where health care providers routinely wind up with the short stick in their dealings with health insurance plans, the passage of the 2009 Managed Care Reform Act¹ offers welcome relief for New York’s health care provider community. The new law, enacted in July 2009, has broad application for licensed health care facilities, providers and consumers,² offering reimbursement protections, greater transparency in contracting and credentialing, and improved guidelines for the payment of health care claims. While the new law swings the pendulum in favor of health care providers, it may not go far enough to ensure that providers receive timely payment for the services they render.

The act’s passage was the product of lengthy negotiations between and among New York’s key players in the managed care arena during the final days of the 2009 state legislative session.³ The act is the latest and most expansive of a series of New York State managed care reform efforts that include the previously enacted External Appeal Law,⁴ the Prior Authorization Law,⁵ the Cooling-off Law,⁶ and the Prompt Pay Law.⁷

Plans to Pay More Promptly