S T A T E   O F   N E W   Y O R K
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                                  1306

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                               (PREFILED)

                             January 9, 2013
                               ___________

Introduced  by  M.  of  A.  ZEBROWSKI  --  read once and referred to the
  Committee on Insurance

AN ACT to amend the insurance law, in relation to imposing a penalty for
  failing to comply with notification  requirements  concerning  certain
  managed health care products

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Paragraph 1 of subsection (a) of section 4803 of the insur-
ance law, as amended by chapter 237 of the laws of 2009, is  amended  to
read as follows:
  (1)  (A)  An  insurer  which offers a managed care product shall, upon
request, make available and disclose to health care professionals  writ-
ten  application procedures and minimum qualification requirements which
a health care professional must meet in order to be  considered  by  the
insurer  for  participation  in  the  in-network benefits portion of the
insurer's network for  the  managed  care  product.  The  insurer  shall
consult with appropriately qualified health care professionals in devel-
oping its qualification requirements for participation in the in-network
benefits  portion of the insurer's network for the managed care product.
An insurer shall complete  review  of  the  health  care  professional's
application  to  participate  in the in-network portion of the insurer's
network and, within ninety days  of  receiving  a  health  care  profes-
sional's  completed application to participate in the insurer's network,
will notify the health care professional as to:  [(A)] (I) whether he or
she is credentialed; or [(B)] (II) whether additional time is  necessary
to  make  a  determination  in  spite  of  the insurer's best efforts or
because of a failure of a third party to  provide  necessary  documenta-
tion,  or  non-routine  or unusual circumstances require additional time
for review.   In such  instances  where  additional  time  is  necessary

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD00418-01-3
              

A. 1306                             2

because  of  a  lack  of  necessary documentation, an insurer shall make
every effort to obtain such information as soon as possible.
  (B)  IF  AN INSURER FAILS TO COMPLY WITH THE NOTIFICATION REQUIREMENTS
IN THIS SECTION WITHIN NINETY DAYS OF RECEIVING A  HEALTH  CARE  PROFES-
SIONAL'S  COMPLETED  APPLICATION  THEN SUCH INSURER WILL BE LIABLE FOR A
CIVIL PENALTY OF FIVE HUNDRED DOLLARS PER DAY PAYABLE TO THE HEALTH CARE
PROFESSIONAL UNTIL SUCH NOTIFICATION  REQUIREMENTS  PRESCRIBED  IN  THIS
SECTION ARE MET.
  S 2. This act shall take effect immediately.