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A04914 Summary:

BILL NOA04914
 
SAME ASNo Same As
 
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
 
                               2017-2018 Regular Sessions
 
                   IN ASSEMBLY
 
                                    February 6, 2017
                                       ___________
 
        Introduced  by  M.  of  A.  SCHIMMINGER -- read once and referred to the
          Committee on Health
 
        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 solely because such
    22  physician is not board-certified.

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD09068-01-7

        A. 4914                             2
 
     1    § 2. Paragraph (a) of subdivision 1 of section 4406-d  of  the  public
     2  health law, as amended by chapter 237 of the laws of 2009, 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 ninety 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  in
    16  spite  of the health care plan's best efforts or because of a failure of
    17  a third party to provide  necessary  documentation,  or  non-routine  or
    18  unusual  circumstances  require  additional  time  for  review.  In such
    19  instances where additional time is necessary because of a lack of neces-
    20  sary documentation, a health plan shall make every effort to obtain such
    21  information as soon as possible. A health care plan may  not  refuse  to
    22  approve an application from a physician to participate in the in-network
    23  portion  of the health care plan's network solely because such physician
    24  is not board-certified.
    25    § 3. Paragraph (a) of subdivision 1 of section 4406-d  of  the  public
    26  health law, as amended by chapter 425 of the laws of 2016, is amended to
    27  read as follows:
    28    (a)  A  health  care  plan  shall,  upon  request,  make available and
    29  disclose to health care professionals written application procedures and
    30  minimum qualification requirements which a health care professional must
    31  meet in order to be considered by the health care plan. The  plan  shall
    32  consult with appropriately qualified health care professionals in devel-
    33  oping  its qualification requirements. A health care plan shall complete
    34  review of the health care professional's application to  participate  in
    35  the  in-network  portion  of  the  health care plan's network and shall,
    36  within sixty days of receiving a health  care  professional's  completed
    37  application to participate in the health care plan's network, notify the
    38  health  care  professional as to: (i) whether he or she is credentialed;
    39  or (ii) whether additional time is necessary  to  make  a  determination
    40  because  of  a  failure of a third party to provide necessary documenta-
    41  tion. In such instances where additional time is necessary because of  a
    42  lack  of  necessary documentation, a health plan shall make every effort
    43  to obtain such information as soon as possible and shall  make  a  final
    44  determination within twenty-one days of receiving the necessary documen-
    45  tation. A health care plan may not refuse to approve an application from
    46  a  physician to participate in the in-network portion of the health care
    47  plan's network solely because such physician is not board-certified.
    48    § 4. Paragraph 1 of subsection (a) of section 4803  of  the  insurance
    49  law,  as  amended by chapter 237 of the laws of 2009, is amended to read
    50  as follows:
    51    (1) An insurer  which  offers  a  managed  care  product  shall,  upon
    52  request,  make available and disclose to health care professionals writ-
    53  ten application procedures and minimum qualification requirements  which
    54  a  health  care  professional must meet in order to be considered by the
    55  insurer for participation in the  in-network  benefits  portion  of  the
    56  insurer's  network  for  the  managed  care  product.  The insurer shall

        A. 4914                             3
 
     1  consult with appropriately qualified health care professionals in devel-
     2  oping its qualification requirements for participation in the in-network
     3  benefits portion of the insurer's network for the managed care  product.
     4  An  insurer  shall  complete  review  of  the health care professional's
     5  application to participate in the in-network portion  of  the  insurer's
     6  network  and,  within  ninety  days  of  receiving a health care profes-
     7  sional's completed application to participate in the insurer's  network,
     8  will notify the health care professional as to: (A) whether he or she is
     9  credentialed;  or  (B)  whether  additional  time is necessary to make a
    10  determination in spite of the insurer's best efforts  or  because  of  a
    11  failure  of  a  third  party to provide necessary documentation, or non-
    12  routine or unusual circumstances require additional time for review.  In
    13  such instances where additional time is necessary because of a  lack  of
    14  necessary  documentation,  an  insurer shall make every effort to obtain
    15  such information as soon as possible.  An  insurer  may  not  refuse  to
    16  approve an application from a physician for participation in the in-net-
    17  work  portion  of the insurer's network solely because such physician is
    18  not board-certified.
    19    § 5. Paragraph 1 of subsection (a) of section 4803  of  the  insurance
    20  law,  as  amended by chapter 425 of the laws of 2016, is amended to read
    21  as follows:
    22    (1) An insurer  which  offers  a  managed  care  product  shall,  upon
    23  request,  make available and disclose to health care professionals writ-
    24  ten application procedures and minimum qualification requirements  which
    25  a  health  care  professional must meet in order to be considered by the
    26  insurer for participation in the  in-network  benefits  portion  of  the
    27  insurer's  network  for  the  managed  care  product.  The insurer shall
    28  consult with appropriately qualified health care professionals in devel-
    29  oping its qualification requirements for participation in the in-network
    30  benefits portion of the insurer's network for the managed care  product.
    31  An  insurer  shall  complete  review  of  the health care professional's
    32  application to participate in the in-network portion  of  the  insurer's
    33  network and, within sixty days of receiving a health care professional's
    34  completed  application  to  participate  in  the insurer's network, will
    35  notify the health care professional as to: (A)  whether  he  or  she  is
    36  credentialed;  or  (B)  whether  additional  time is necessary to make a
    37  determination because of a failure of a third party to provide necessary
    38  documentation. In such instances  where  additional  time  is  necessary
    39  because  of  a  lack  of  necessary documentation, an insurer shall make
    40  every effort to obtain such information as soon as  possible  and  shall
    41  make  a  final  determination  within  twenty-one  days of receiving the
    42  necessary documentation. An insurer may not refuse to approve an  appli-
    43  cation  from  a physician for participation in the in-network portion of
    44  the insurer's network solely because such physician is not  board-certi-
    45  fied.
    46    §  6.  This act shall take effect immediately; provided, however, that
    47  if chapter 425 of the laws of 2016 shall not have  taken  effect  on  or
    48  before  such  date  then  sections three and five of this act shall take
    49  effect on the same date and in the same manner as such  chapter  of  the
    50  laws of 2016 takes effect.
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