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A04914 Summary:

BILL NOA04914B
 
SAME ASSAME AS S07357-A
 
SPONSORSchimminger
 
COSPNSR
 
MLTSPNSR
 
Amd §§2801-b & 4406-d, Pub Health L; amd §4803, Ins L
 
Relates to improper practices relating to staff membership or professional privileges of a physician and such physician's board certification.
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A04914 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         4914--B
 
                               2017-2018 Regular Sessions
 
                   IN ASSEMBLY
 
                                    February 6, 2017
                                       ___________
 
        Introduced  by  M.  of  A.  SCHIMMINGER -- read once and referred to the
          Committee on Health -- recommitted  to  the  Committee  on  Health  in
          accordance  with Assembly Rule 3, sec. 2 -- committee discharged, bill
          amended, ordered reprinted as amended and recommitted to said  commit-
          tee  --  again  reported  from said committee with amendments, ordered
          reprinted as amended and recommitted to said committee
 
        AN ACT to amend the public health law and the insurance law, in relation
          to improper practices relating to  staff  membership  or  professional
          privileges of a physician and board certification
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
 
     1    Section 1. Subdivision 1 of section 2801-b of the public  health  law,
     2  as  amended  by  chapter  605 of the laws of 2008, is amended to read as
     3  follows:
     4    1. It shall be an improper practice for the governing body of a hospi-
     5  tal to refuse to act upon an application for staff membership or profes-
     6  sional privileges or to deny or withhold from a  physician,  podiatrist,
     7  optometrist,  dentist  or  licensed  midwife staff membership or profes-
     8  sional privileges in a hospital, or to exclude  or  expel  a  physician,
     9  podiatrist,  optometrist, dentist or licensed midwife from staff member-
    10  ship in a hospital or curtail, terminate or diminish in any way a physi-
    11  cian's, podiatrist's, optometrist's,  dentist's  or  licensed  midwife's
    12  professional  privileges  in  a  hospital,  without  stating the reasons
    13  therefor, or if the reasons stated are unrelated to standards of patient
    14  care, patient welfare, the objectives of the institution or the  charac-
    15  ter or competency of the applicant. It shall be an improper practice for
    16  a  governing  body of a hospital to refuse to act upon an application or
    17  to deny or to withhold staff membership or professional privileges to  a
    18  podiatrist  based solely upon a practitioner's category of licensure. It
    19  shall be an improper practice for a governing  body  of  a  hospital  to
    20  refuse  to  act  upon  an  application  or  to deny or to withhold staff
    21  membership or professional privileges of a physician who was  previously
    22  board-certified  and  who  has  not maintained such certification solely
    23  because such physician is not board-certified.
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD09068-06-8

        A. 4914--B                          2
 
     1    § 2. Paragraph (a) of subdivision 1 of section 4406-d  of  the  public
     2  health law, as amended by chapter 425 of the laws of 2016, is amended to
     3  read as follows:
     4    (a)  A  health  care  plan  shall,  upon  request,  make available and
     5  disclose to health care professionals written application procedures and
     6  minimum qualification requirements which a health care professional must
     7  meet in order to be considered by the health care plan. The  plan  shall
     8  consult with appropriately qualified health care professionals in devel-
     9  oping  its qualification requirements. A health care plan shall complete
    10  review of the health care professional's application to  participate  in
    11  the  in-network  portion  of  the  health care plan's network and shall,
    12  within sixty days of receiving a health  care  professional's  completed
    13  application to participate in the health care plan's network, notify the
    14  health  care  professional as to: (i) whether he or she is credentialed;
    15  or (ii) whether additional time is necessary  to  make  a  determination
    16  because  of  a  failure of a third party to provide necessary documenta-
    17  tion. In such instances where additional time is necessary because of  a
    18  lack  of  necessary documentation, a health plan shall make every effort
    19  to obtain such information as soon as possible and shall  make  a  final
    20  determination within twenty-one days of receiving the necessary documen-
    21  tation. A health care plan may not refuse to approve an application from
    22  a  physician,  who  was previously board-certified and who has not main-
    23  tained such certification, to participate in the in-network  portion  of
    24  the  health  care  plan's  network  solely because such physician is not
    25  board-certified.
    26    § 3. Paragraph 1 of subsection (a) of section 4803  of  the  insurance
    27  law,  as  amended by chapter 425 of the laws of 2016, is amended to read
    28  as follows:
    29    (1) An insurer  which  offers  a  managed  care  product  shall,  upon
    30  request,  make available and disclose to health care professionals writ-
    31  ten application procedures and minimum qualification requirements  which
    32  a  health  care  professional must meet in order to be considered by the
    33  insurer for participation in the  in-network  benefits  portion  of  the
    34  insurer's  network  for  the  managed  care  product.  The insurer shall
    35  consult with appropriately qualified health care professionals in devel-
    36  oping its qualification requirements for participation in the in-network
    37  benefits portion of the insurer's network for the managed care  product.
    38  An  insurer  shall  complete  review  of  the health care professional's
    39  application to participate in the in-network portion  of  the  insurer's
    40  network and, within sixty days of receiving a health care professional's
    41  completed  application  to  participate  in  the insurer's network, will
    42  notify the health care professional as to: (A)  whether  he  or  she  is
    43  credentialed;  or  (B)  whether  additional  time is necessary to make a
    44  determination because of a failure of a third party to provide necessary
    45  documentation. In such instances  where  additional  time  is  necessary
    46  because  of  a  lack  of  necessary documentation, an insurer shall make
    47  every effort to obtain such information as soon as  possible  and  shall
    48  make  a  final  determination  within  twenty-one  days of receiving the
    49  necessary documentation. An insurer may not refuse to approve an  appli-
    50  cation  from a physician, who was previously board-certified and who has
    51  not maintained such certification, for participation in  the  in-network
    52  portion  of  the  insurer's network solely because such physician is not
    53  board-certified.
    54    § 4. This act shall take effect immediately.
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