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

                                  4239

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                            February 1, 2013
                               ___________

Introduced  by M. of A. PRETLOW -- read once and referred to the Commit-
  tee on Insurance

AN ACT to amend the insurance  law,  in  relation  to  the  health  care
  consumer and provider protection and equity act

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

  Section 1. The insurance law is amended by adding a new article 57  to
read as follows:
                                ARTICLE 57
              HEALTH CARE CONSUMER AND PROVIDER PROTECTION
                             AND EQUITY ACT
SECTION 5701. LEGISLATIVE FINDINGS.
        5702. COLLECTIVE ACTION BY COMPETING PHYSICIANS.
        5703. APPLICATION FOR HEARING.
        5704. FEE FOR REGISTRATION OF AUTHORIZED THIRD PARTIES.
        5705. REGULATIONS.
        5706. GOOD FAITH NEGOTIATIONS.
        5707. PROHIBITION OF COLLECTIVE CESSATION OF SERVICES.
        5708. NO INTERFERENCE WITH OTHER STATUTORY RIGHTS.
        5709. DEFINITIONS.
  S 5701. LEGISLATIVE FINDINGS. THE LEGISLATURE FINDS AND DECLARES THAT:
  (A)  UNDER  THE  MCCARRAN-FERGUSON  ACT  OF 1945, 15 U.S.C. S 1011, ET
SEQ., INSURANCE COMPANIES ARE EXEMPT FROM FEDERAL ANTI-TRUST  LAWS  THAT
OTHERWISE APPLY TO MOST OTHER BUSINESSES;
  (B)  ACTIVE,  ROBUST AND FULLY COMPETITIVE MARKETS FOR HEALTH CARE AND
DENTAL SERVICES PROVIDE THE BEST OPPORTUNITY FOR THE RESIDENTS  OF  THIS
STATE  TO  RECEIVE  HIGH-QUALITY  HEALTH  CARE AND DENTAL SERVICES AT AN
APPROPRIATE COST;
  (C) A SUBSTANTIAL AMOUNT OF HEALTH CARE AND DENTAL  SERVICES  IN  THIS
STATE  IS  PURCHASED  FOR  THE  BENEFIT OF PATIENTS BY HEALTH AND DENTAL
INSURANCE CARRIERS ENGAGED IN THE FINANCING OF HEALTH  CARE  AND  DENTAL

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD07579-01-3
              

A. 4239                             2

SERVICES  OR  IS  OTHERWISE DELIVERED SUBJECT TO THE TERMS OF AGREEMENTS
BETWEEN CARRIERS AND PHYSICIANS AND DENTISTS;
  (D)  CARRIERS  ARE  ABLE TO CONTROL THE FLOW OF PATIENTS TO PHYSICIANS
AND DENTISTS THROUGH COMPELLING FINANCIAL  INCENTIVES  FOR  PATIENTS  IN
THEIR  HEALTH  AND DENTAL BENEFITS PLANS TO UTILIZE ONLY THE SERVICES OF
PHYSICIANS AND DENTISTS WITH WHOM THE CARRIERS HAVE CONTRACTED;
  (E) CARRIERS ALSO CONTROL THE HEALTH CARE AND DENTAL SERVICES RENDERED
TO PATIENTS THROUGH UTILIZATION MANAGEMENT AND OTHER MANAGED CARE  TOOLS
AND ASSOCIATED COVERAGE AND PAYMENT POLICIES;
  (F)  CARRIERS  ARE  OFTEN  ABLE  TO VIRTUALLY DICTATE THE TERMS OF THE
CONTRACTS THAT THEY OFFER PHYSICIANS AND  DENTISTS  AND  COMMONLY  OFFER
THESE CONTRACTS ON A TAKE-IT-OR-LEAVE-IT BASIS;
  (G)  THE  POWER  OF  CARRIERS TO UNILATERALLY IMPOSE PROVIDER CONTRACT
TERMS JEOPARDIZES THE ABILITY OF PHYSICIANS AND DENTISTS TO DELIVER  THE
SUPERIOR QUALITY HEALTH CARE AND DENTAL SERVICES TRADITIONALLY AVAILABLE
IN THIS STATE;
  (H)  PHYSICIANS  AND  DENTISTS  DO NOT HAVE SUFFICIENT MARKET POWER TO
REJECT UNFAIR PROVIDER CONTRACT TERMS OFFERED BY  CARRIERS  THAT  IMPEDE
THEIR  ABILITY TO DELIVER MEDICALLY APPROPRIATE CARE WITHOUT UNDUE DELAY
OR DIFFICULTIES;
  (I) INADEQUATE REIMBURSEMENT AND OTHER UNFAIR PAYMENT TERMS OFFERED BY
CARRIERS ADVERSELY AFFECT THE QUALITY OF PATIENT CARE AND ACCESS TO CARE
BY REDUCING THE RESOURCES THAT PHYSICIANS AND  DENTISTS  CAN  DEVOTE  TO
PATIENT  CARE  AND  DECREASING THE TIME THAT PHYSICIANS AND DENTISTS ARE
ABLE TO SPEND WITH THEIR PATIENTS;
  (J) INEQUITABLE REIMBURSEMENT AND  OTHER  UNFAIR  PAYMENT  TERMS  ALSO
ENDANGER  THE HEALTH CARE INFRASTRUCTURE AND MEDICAL PROGRESS BY DIVERT-
ING CAPITAL NEEDED FOR REINVESTMENT IN THE HEALTH CARE DELIVERY  SYSTEM,
CURTAILING  THE  PURCHASE OF STATE-OF-THE-ART TECHNOLOGY, THE PURSUIT OF
MEDICAL RESEARCH, AND EXPANSION OF MEDICAL SERVICES, ALL TO  THE  DETRI-
MENT OF THE RESIDENTS OF THIS STATE;
  (K)  THE  INEVITABLE  COLLATERAL REDUCTION AND MIGRATION OF THE HEALTH
CARE WORK FORCE WILL ALSO HAVE NEGATIVE CONSEQUENCES FOR THE ECONOMY  OF
THIS STATE;
  (L)  EMPOWERING INDEPENDENT PHYSICIANS AND DENTISTS TO JOINTLY NEGOTI-
ATE WITH CARRIERS AS PROVIDED IN THIS  ARTICLE  WILL  HELP  RESTORE  THE
COMPETITIVE  BALANCE  AND  IMPROVE COMPETITION IN THE MARKETS FOR HEALTH
CARE AND DENTAL SERVICES IN THIS STATE, THEREBY PROVIDING  BENEFITS  FOR
CONSUMERS, PHYSICIANS AND DENTISTS AND LESS DOMINANT CARRIERS;
  (M) THIS ARTICLE IS NECESSARY AND PROPER, AND CONSTITUTES AN APPROPRI-
ATE  EXERCISE OF THE AUTHORITY OF THIS STATE TO REGULATE THE BUSINESS OF
INSURANCE AND THE DELIVERY OF HEALTH CARE AND DENTAL SERVICES;
  (N) THE PRO-COMPETITIVE AND OTHER BENEFITS OF THE  JOINT  NEGOTIATIONS
AND  RELATED  JOINT  ACTIVITY AUTHORIZED BY THIS ARTICLE, INCLUDING, BUT
NOT LIMITED TO, RESTORING THE COMPETITIVE  BALANCE  IN  THE  MARKET  FOR
HEALTH CARE SERVICES, PROTECTING ACCESS TO QUALITY PATIENT CARE, PROMOT-
ING  THE  HEALTH CARE INFRASTRUCTURE AND MEDICAL PROGRESS, AND IMPROVING
COMMUNICATIONS, OUTWEIGH ANY POTENTIAL ANTI-COMPETITIVE EFFECTS OF  THIS
ARTICLE; AND
  (O)  IT  IS  THE INTENTION OF THE LEGISLATURE TO AUTHORIZE INDEPENDENT
PHYSICIANS AND DENTISTS TO JOINTLY NEGOTIATE WITH CARRIERS AND TO QUALI-
FY  SUCH  JOINT  NEGOTIATIONS  AND  RELATED  JOINT  ACTIVITIES  FOR  THE
STATE-ACTION  EXEMPTION TO THE FEDERAL ANTITRUST LAWS THROUGH THE ARTIC-
ULATED STATE POLICY AND ACTIVE SUPERVISION PROVIDED UNDER THIS ARTICLE.
  S 5702. COLLECTIVE  ACTION  BY  COMPETING  PHYSICIANS.  (A)  COMPETING
PHYSICIANS  MAY  MEET AND COMMUNICATE IN ORDER TO COLLECTIVELY NEGOTIATE

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WITH A HEALTH BENEFIT PLAN CONCERNING ANY  OF  THE  CONTRACT  TERMS  AND
CONDITIONS  DESCRIBED  IN  THIS  SUBSECTION,  BUT  MAY NOT NEGOTIATE THE
EXCLUSION OF PROVIDERS WHO ARE NON-PHYSICIANS FROM DIRECT  REIMBURSEMENT
BY  A  HEALTH  BENEFIT  PLAN, AND MAY NOT NEGOTIATE THE SETTING IN WHICH
PROVIDERS WHO ARE NON-PHYSICIANS DELIVER SERVICES. COMPETING  PHYSICIANS
MAY  NOT  ENGAGE  IN  A  BOYCOTT  RELATED TO THESE TERMS AND CONDITIONS.
COMPETING PHYSICIANS MAY MEET AND COMMUNICATE CONCERNING:
  (1) PHYSICIAN CLINICAL PRACTICE GUIDELINES AND COVERAGE CRITERIA;
  (2) THE RESPECTIVE LIABILITY OF PHYSICIANS AND THE HEALTH BENEFIT PLAN
FOR THE TREATMENT OR LACK OF TREATMENT OF INSURED OR ENROLLED PERSONS;
  (3) ADMINISTRATIVE PROCEDURES, INCLUDING METHODS  AND  TIMING  OF  THE
PAYMENT OF SERVICES TO PHYSICIANS;
  (4) PROCEDURES FOR THE RESOLUTION OF DISPUTES BETWEEN THE HEALTH BENE-
FIT PLAN AND PHYSICIANS;
  (5) PATIENT REFERRAL PROCEDURES;
  (6) THE FORMULATION AND APPLICATION OF REIMBURSEMENT METHODOLOGY;
  (7) QUALITY ASSURANCE PROGRAMS;
  (8) HEALTH SERVICE UTILIZATION REVIEW PROCEDURES; AND
  (9)  CRITERIA TO BE USED BY HEALTH BENEFIT PLANS FOR THE SELECTION AND
TERMINATION OF PHYSICIANS, INCLUDING  WHETHER  TO  ENGAGE  IN  SELECTIVE
CONTRACTING.
  (B)  AN AUTHORIZED THIRD PARTY THAT INTENDS TO NEGOTIATE WITH A HEALTH
BENEFIT PLAN THE ITEMS IDENTIFIED UNDER SUBSECTION (A) OF  THIS  SECTION
SHALL PROVIDE THE INDEPENDENT REVIEW PANEL, AS ESTABLISHED BY SUBSECTION
(C)  OF  THIS  SECTION, WITH WRITTEN NOTICE OF THE INTENDED NEGOTIATIONS
BEFORE THE NEGOTIATIONS BEGIN.
  (C) THE INDEPENDENT REVIEW PANEL SHALL CONSIST OF THREE MEMBERS:
  (1) THE ATTORNEY GENERAL, OR  HIS  OR  HER  DESIGNEE  WHO  SHALL  HAVE
PARTICULAR EXPERTISE IN THE AREA OF ANTITRUST LAW;
  (2) THE STATE COMMISSIONER OF HEALTH, OR HIS OR HER DESIGNEE; AND
  (3) THE STATE COMMISSIONER OF LABOR, OR HIS OR HER DESIGNEE.
  (D)  IN  EXERCISING THE COLLECTIVE RIGHTS GRANTED BY SUBSECTION (A) OF
THIS SECTION:
  (1) PHYSICIANS MAY COMMUNICATE WITH EACH OTHER  WITH  RESPECT  TO  THE
CONTRACTUAL  TERMS AND CONDITIONS TO BE NEGOTIATED WITH A HEALTH BENEFIT
PLAN;
  (2) PHYSICIANS MAY COMMUNICATE WITH AN AUTHORIZED THIRD PARTY  REGARD-
ING THE TERMS AND CONDITIONS OF CONTRACTS ALLOWED UNDER THIS SECTION;
  (3) THE AUTHORIZED THIRD PARTY IS THE SOLE PARTY AUTHORIZED TO NEGOTI-
ATE  WITH  A  HEALTH BENEFIT PLAN ON BEHALF OF A DEFINED GROUP OF PHYSI-
CIANS;
  (4) PHYSICIANS CAN BE BOUND BY THE TERMS AND CONDITIONS NEGOTIATED  BY
THE AUTHORIZED THIRD PARTY THAT REPRESENTS THEIR INTERESTS;
  (5)  A  HEALTH  BENEFIT  PLAN  COMMUNICATING  OR  NEGOTIATING WITH THE
AUTHORIZED THIRD PARTY MAY CONTRACT WITH, OR  OFFER  DIFFERENT  CONTRACT
TERMS AND CONDITIONS TO, INDIVIDUAL COMPETING PHYSICIANS;
  (6)  AN  AUTHORIZED  THIRD  PARTY  MAY  NOT REPRESENT MORE THAN THIRTY
PERCENT OF THE MARKET OF PRACTICING  PHYSICIANS  FOR  THE  PROVISION  OF
SERVICES  IN  THE GEOGRAPHIC SERVICE AREA OR PROPOSED GEOGRAPHIC SERVICE
AREA, IF THE HEALTH BENEFIT PLAN HAS LESS THAN  A  FIVE  PERCENT  MARKET
SHARE  AS  DETERMINED  BY THE NUMBER OF COVERED LIVES AS REPORTED BY THE
SUPERINTENDENT  OF  THE  INSURANCE  DEPARTMENT  FOR  THE  MOST  RECENTLY
COMPLETED  CALENDAR YEAR OR BY THE ACTUAL NUMBER OF CONSUMERS OF PREPAID
COMPREHENSIVE HEALTH SERVICES; IN THIS PARAGRAPH, "COVERED LIVES"  MEANS
THE  TOTAL  NUMBER OF INDIVIDUALS WHO ARE ENTITLED TO BENEFITS UNDER THE
HEALTH BENEFIT PLAN;

A. 4239                             4

  (7) THE INDEPENDENT REVIEW PANEL MAY LIMIT THE PERCENTAGE OF  PRACTIC-
ING  PHYSICIANS  REPRESENTED  BY AN AUTHORIZED THIRD PARTY; HOWEVER, THE
LIMITATION MAY NOT BE LESS THAN THIRTY PERCENT OF THE MARKET OF PRACTIC-
ING PHYSICIANS IN THE GEOGRAPHIC SERVICE  AREA  OR  PROPOSED  GEOGRAPHIC
SERVICE  AREA; WHEN DETERMINING WHETHER TO IMPOSE A LIMITATION DESCRIBED
UNDER THIS PARAGRAPH, THE ATTORNEY GENERAL SHALL CONSIDER THE PROVISIONS
DESCRIBED UNDER SUBSECTIONS (F), (G) AND (H) OF THIS SECTION; THIS PARA-
GRAPH DOES NOT APPLY IF THE  MARKET  OF  PRACTICING  PHYSICIANS  IN  THE
GEOGRAPHIC  SERVICE AREA OR PROPOSED GEOGRAPHIC SERVICE AREA CONSISTS OF
FORTY OR FEWER INDIVIDUALS; AND
  (8) THE AUTHORIZED THIRD PARTY SHALL COMPLY  WITH  THE  PROVISIONS  OF
SUBSECTION (E) OF THIS SECTION.
  (E)  A  PERSON ACTING OR PROPOSING TO ACT AS AN AUTHORIZED THIRD PARTY
UNDER THIS SECTION SHALL:
  (1) BEFORE ENGAGING IN COLLECTIVE NEGOTIATIONS WITH A  HEALTH  BENEFIT
PLAN:
  (A)  FILE WITH THE INDEPENDENT REVIEW PANEL THE INFORMATION THAT IDEN-
TIFIES THE AUTHORIZED THIRD PARTY, THE  PHYSICIANS  REPRESENTED  BY  THE
THIRD  PARTY,  THE  AUTHORIZED  THIRD PARTY'S PLAN OF OPERATION, AND THE
AUTHORIZED THIRD PARTY'S  PROCEDURES  TO  ENSURE  COMPLIANCE  WITH  THIS
SECTION;
  (B)  FURNISH TO THE INDEPENDENT REVIEW PANEL FOR ITS APPROVAL, A BRIEF
REPORT THAT IDENTIFIES THE PROPOSED SUBJECT MATTER OF  THE  NEGOTIATIONS
OR  DISCUSSIONS WITH A HEALTH BENEFIT PLAN AND THAT CONTAINS AN EXPLANA-
TION OF THE EFFICIENCIES OR BENEFITS THAT ARE EXPECTED  TO  BE  ACHIEVED
THROUGH THE COLLECTIVE NEGOTIATIONS, PRODUCT AND GEOGRAPHIC MARKET DEFI-
NITION,  CURRENT  PRICE LEVELS, AVAILABILITY OF SUBSTITUTES, AND EASE OF
ENTRY FOR NEW COMPETING PHYSICIANS;
  (C) THE PANEL SHALL REVIEW WHETHER THE GROUP OF PHYSICIANS REPRESENTED
BY THE AUTHORIZED THIRD PARTY IS APPROPRIATE TO REPRESENT THE  INTERESTS
INVOLVED  IN  THE  NEGOTIATIONS; THE PANEL MAY NOT APPROVE THE REPORT IF
THE GROUP OF PHYSICIANS IS NOT APPROPRIATE TO  REPRESENT  THE  INTERESTS
INVOLVED  IN THE NEGOTIATIONS OR IF THE PROPOSED NEGOTIATIONS EXCEED THE
AUTHORITY GRANTED IN THIS CHAPTER AND, IF THE GROUP IS  NOT  APPROPRIATE
OR  THE NEGOTIATIONS EXCEED THE GRANTED AUTHORITY, SHALL PROVIDE WRITTEN
NOTICE PROHIBITING THE COLLECTIVE NEGOTIATIONS FROM PROCEEDING, AT WHICH
TIME THE PROPOSED AUTHORIZED THIRD PARTY MAY REQUEST A HEARING  PURSUANT
TO SECTION FIVE THOUSAND SEVEN HUNDRED THREE OF THIS ARTICLE;
  (D)  THE AUTHORIZED THIRD PARTY SHALL PROVIDE SUPPLEMENTAL INFORMATION
TO THE PANEL AS NEW INFORMATION BECOMES AVAILABLE  THAT  INDICATES  THAT
THE  SUBJECT  MATTER  OF  NEGOTIATIONS  WITH THE HEALTH BENEFIT PLAN HAS
CHANGED OR WILL CHANGE; THE PANEL MAY, AS IT DEEMS APPROPRIATE,  REQUEST
ADDITIONAL INFORMATION IN ORDER TO ASSESS THE LIKELY COMPETITIVE EFFECTS
OF  NEGOTIATION; THE PANEL MAY ALSO SOLICIT INPUT FROM OTHER PHYSICIANS,
AFFECTED HEALTH PLANS, AND PATIENTS REGARDING THE POTENTIAL  COMPETITIVE
EFFECTS OF NEGOTIATIONS;
  (E) WITHIN FOURTEEN DAYS AFTER RECEIVING A HEALTH BENEFIT PLAN'S DECI-
SION  TO  DECLINE  TO  NEGOTIATE OR TO TERMINATE NEGOTIATIONS, OR WITHIN
FOURTEEN DAYS AFTER REQUESTING NEGOTIATIONS WITH A HEALTH  BENEFIT  PLAN
THAT  FAILS  TO RESPOND WITHIN THAT TIME, REPORT TO THE ATTORNEY GENERAL
THAT NEGOTIATIONS HAVE ENDED OR HAVE BEEN DECLINED;
  (2) WHILE NEGOTIATING WITH A HEALTH BENEFIT PLAN:
  (A) PROVIDE THE INDEPENDENT REVIEW PANEL, UPON THE INDEPENDENT  REVIEW
PANEL'S  REQUEST,  WITH  COPIES  OF  ALL WRITTEN COMMUNICATIONS THAT ARE
RELEVANT TO THE NEGOTIATIONS, THAT ARE IN THE POSSESSION OF THE  AUTHOR-
IZED THIRD PARTY, AND THAT ARE BETWEEN:

A. 4239                             5

  I. PHYSICIANS AND THE HEALTH BENEFIT PLAN,
  II. PHYSICIANS AND AUTHORIZED THIRD PARTIES,
  III. AUTHORIZED THIRD PARTIES AND HEALTH PLANS,
  IV. THE INDIVIDUAL PHYSICIANS, AND
  V. AUTHORIZED THIRD PARTIES;
  (B) BEFORE REPORTING THE RESULTS OF NEGOTIATIONS WITH A HEALTH BENEFIT
PLAN  AND  BEFORE GIVING PHYSICIANS AN EVALUATION OF ANY OFFER MADE BY A
HEALTH BENEFIT PLAN, PROVIDE TO THE INDEPENDENT  REVIEW  PANEL  FOR  ITS
APPROVAL,  A COPY OF ALL COMMUNICATIONS TO BE MADE TO PHYSICIANS RELATED
TO THE NEGOTIATIONS, DISCUSSION, AND HEALTH BENEFIT PLAN OFFERS.
  (3) MUST BE AN ORGANIZATION THAT REPRESENTS BOTH CONSUMERS AND PROVID-
ERS OF HEALTH CARE.
  (F) THE INDEPENDENT REVIEW PANEL SHALL EITHER  APPROVE  OR  DISAPPROVE
THE  CONTRACT  THAT WAS THE SUBJECT OF THE COLLECTIVE NEGOTIATION WITHIN
SIXTY DAYS AFTER RECEIVING THE REPORTS REQUIRED UNDER SUBSECTION (D)  OF
THIS  SECTION.  IF  THE  CONTRACT IS DISAPPROVED, THE INDEPENDENT REVIEW
PANEL SHALL FURNISH A WRITTEN EXPLANATION.  UPON DISAPPROVAL, THE  INDE-
PENDENT  REVIEW  PANEL SHALL DENOTE ANY DEFICIENCIES ALONG WITH A STATE-
MENT OF SPECIFIC REMEDIAL MEASURES THAT  WOULD  CORRECT  ANY  IDENTIFIED
DEFICIENCIES.  AN  AUTHORIZED  THIRD PARTY WHO FAILS TO OBTAIN THE INDE-
PENDENT REVIEW PANEL'S APPROVAL IS CONSIDERED TO BE ACTING  OUTSIDE  THE
AUTHORITY OF THIS SECTION.
  (G)  THE  INDEPENDENT  REVIEW PANEL SHALL APPROVE A COLLECTIVE NEGOTI-
ATION CONTRACT IF:
  (1) THE COMPETITIVE AND OTHER BENEFITS OF THE CONTRACT TERMS  OUTWEIGH
ANY ANTICOMPETITIVE EFFECTS; AND
  (2)  THE  CONTRACT TERMS ARE CONSISTENT WITH OTHER APPLICABLE LAWS AND
REGULATIONS.
  (H) THE COMPETITIVE AND OTHER BENEFITS OF JOINT NEGOTIATIONS OR  NEGO-
TIATED PROVIDER CONTRACT TERMS MUST INCLUDE:
  (1)  RESTORATION  OF  THE COMPETITIVE BALANCE IN THE MARKET FOR HEALTH
CARE SERVICES;
  (2) PROTECTIONS FOR ACCESS TO QUALITY PATIENT CARE;
  (3) PROMOTION OF HEALTH CARE INFRASTRUCTURE AND  MEDICAL  ADVANCEMENT;
OR
  (4)  IMPROVED  COMMUNICATIONS BETWEEN HEALTH CARE PROVIDERS AND HEALTH
CARE INSURERS.
  (I) WHEN WEIGHING THE ANTICOMPETITIVE EFFECTS OF CONTRACT  TERMS,  THE
INDEPENDENT REVIEW PANEL SHALL CONSIDER WHETHER THE TERMS:
  (1) PROVIDE FOR EXCESSIVE PAYMENTS; OR
  (2)  CONTRIBUTE TO THE ESCALATION OF THE COST OF PROVIDING HEALTH CARE
SERVICES.
  (J) THIS SECTION DOES NOT AUTHORIZE COMPETING  PHYSICIANS  TO  ACT  IN
CONCERT  IN  RESPONSE  TO  A  REPORT ISSUED BY AN AUTHORIZED THIRD PARTY
RELATED TO THE AUTHORIZED THIRD PARTY'S DISCUSSION OR NEGOTIATIONS  WITH
A  HEALTH  BENEFIT  PLAN.  THE  AUTHORIZED  THIRD PARTY SHALL ADVISE THE
PHYSICIANS OF THE PROVISIONS OF THIS SUBSECTION AND SHALL WARN  THEM  OF
THE POTENTIAL FOR LEGAL ACTION AGAINST THOSE WHO VIOLATE STATE OR FEDER-
AL ANTITRUST LAWS BY EXCEEDING THE AUTHORITY GRANTED UNDER THIS SECTION.
  (K)  A  CONTRACT  ALLOWED  UNDER THIS SECTION MAY NOT EXCEED A TERM OF
FIVE YEARS.
  (L) THE DOCUMENTS RELATING TO A COLLECTIVE NEGOTIATION DESCRIBED UNDER
THIS SECTION THAT ARE IN THE POSSESSION OF THE  DEPARTMENT  OF  LAW  ARE
CONFIDENTIAL AND NOT OPEN TO PUBLIC INSPECTION.
  (M)  NOTHING  IN THIS SECTION SHALL BE CONSTRUED AS EXEMPTING FROM THE
APPLICATION OF THE ANTITRUST LAWS THE CONDUCT OF  PROVIDERS  OR  NEGOTI-

A. 4239                             6

ATIONS  OR AGREEMENTS BETWEEN PROVIDERS AND A HEALTH BENEFIT PLAN IF THE
PURPOSE OR EFFECT OF THE CONDUCT, NEGOTIATIONS, OR AGREEMENTS WOULD  BE,
DIRECTLY   OR   INDIRECTLY,  TO  EXCLUDE,  LIMIT  THE  PARTICIPATION  OR
REIMBURSEMENT  OF,  OR  OTHERWISE  LIMIT  THE  SCOPE  OF  SERVICES TO BE
PROVIDED BY SEPARATE OR COMPETING CLASSES OF PROVIDERS WHO  PRACTICE  OR
SEEK  TO  PRACTICE WITHIN THE SCOPE OF THE OCCUPATIONAL LICENSES HELD BY
THE PROVIDERS.
  (N) IN THIS SECTION, "GEOGRAPHIC SERVICE AREA"  MEANS  THE  GEOGRAPHIC
AREA OF THE PHYSICIANS SEEKING TO JOINTLY NEGOTIATE.
  S 5703. APPLICATION FOR HEARING. (A) WITHIN THIRTY DAYS FROM THE MAIL-
ING  BY  THE INDEPENDENT REVIEW PANEL OF THE NOTICE OF DISAPPROVAL OF AN
APPLICATION BY A PROPOSED AUTHORIZED THIRD  PARTY  REPRESENTATIVE  UNDER
SUBSECTION  (E) OF SECTION FIVE THOUSAND SEVEN HUNDRED TWO OF THIS ARTI-
CLE, SAID REPRESENTATIVE MAY MAKE A WRITTEN APPLICATION TO THE INDEPEND-
ENT REVIEW PANEL FOR A HEARING, THE SOLE PURPOSE OF WHICH  WOULD  BE  TO
REVIEW THE INDEPENDENT REVIEW PANEL'S DISAPPROVAL.
  (B)  UPON RECEIPT OF A TIMELY APPLICATION FOR A HEARING, THE INDEPEND-
ENT REVIEW PANEL SHALL SCHEDULE AND CONDUCT AN  ADMINISTRATIVE  HEARING.
THE  HEARING  SHALL BE HELD WITHIN THIRTY DAYS OF THE APPLICATION UNLESS
THE REPRESENTATIVE SEEKS AN EXTENSION.
  (C) THE INDEPENDENT REVIEW PANEL SHALL APPOINT A NEUTRAL HEARING OFFI-
CER TO PRESIDE OVER THE HEARING.
  S 5704. FEE FOR REGISTRATION OF  AUTHORIZED  THIRD  PARTIES.  (A)  THE
INDEPENDENT  REVIEW  PANEL  SHALL  ADOPT  REGULATIONS THAT ESTABLISH THE
AMOUNT AND MANNER OF PAYMENT OF A REGISTRATION FEE FOR AUTHORIZED  THIRD
PARTIES.  THE  INDEPENDENT REVIEW PANEL SHALL ESTABLISH THE FEE LEVEL SO
THAT THE TOTAL AMOUNT OF FEES COLLECTED FROM  AUTHORIZED  THIRD  PARTIES
APPROXIMATELY  EQUALS  THE  ACTUAL REGULATORY COSTS FOR THE OVERSIGHT OF
JOINT NEGOTIATIONS BETWEEN PHYSICIANS  AND  HEALTH  BENEFIT  PLANS.  THE
INDEPENDENT  REVIEW  PANEL SHALL ANNUALLY REVIEW THE FEE LEVEL TO DETER-
MINE WHETHER  THE  REGULATORY  COSTS  ARE  APPROXIMATELY  EQUAL  TO  FEE
COLLECTIONS.  IF THE REVIEW INDICATES THAT THE FEE COLLECTIONS AND REGU-
LATORY COSTS ARE NOT APPROXIMATELY EQUAL, THE INDEPENDENT  REVIEW  PANEL
SHALL  CALCULATE  FEE  ADJUSTMENTS  AND  ADOPT  REGULATIONS  UNDER  THIS
SUBSECTION TO IMPLEMENT THE ADJUSTMENTS. IN JANUARY OF  EACH  YEAR,  THE
INDEPENDENT REVIEW PANEL SHALL REPORT ON THE FEE LEVEL AND REVISIONS FOR
THE  PREVIOUS YEAR UNDER THIS SUBSECTION TO THE OFFICE OF MANAGEMENT AND
BUDGET.
  (B) IN THIS SECTION, "REGULATORY COSTS" MEANS COSTS OF THE INDEPENDENT
REVIEW PANEL THAT ARE ATTRIBUTABLE TO OVERSIGHT  OF  JOINT  NEGOTIATIONS
BETWEEN PHYSICIANS AND HEALTH BENEFIT PLANS.
  S 5705. REGULATIONS. THE ATTORNEY GENERAL MAY PROMULGATE ANY RULES AND
REGULATIONS NECESSARY TO IMPLEMENT THIS ARTICLE.
  S  5706. GOOD FAITH NEGOTIATIONS. A HEALTH BENEFIT PLAN AND AN AUTHOR-
IZED THIRD PARTY SHALL NEGOTIATE IN GOOD FAITH REGARDING THE  TERMS  AND
CONDITIONS OF PHYSICIAN OR DENTIST CONTRACTS PURSUANT TO THIS ARTICLE.
  S   5707.   PROHIBITION  OF  COLLECTIVE  CESSATION  OF  SERVICES.  THE
PROVISIONS OF THIS ARTICLE SHALL NOT BE CONSTRUED TO PERMIT TWO OR  MORE
PHYSICIANS  OR  DENTISTS  TO  JOINTLY ENGAGE IN A COORDINATED CESSATION,
REDUCTION OR LIMITATION OF THE  HEALTH  CARE  OR  DENTAL  SERVICES  THEY
PROVIDE.
  S 5708. NO INTERFERENCE WITH OTHER STATUTORY RIGHTS. THE PROVISIONS OF
THIS  ARTICLE SHALL NOT AFFECT THE COLLECTIVE BARGAINING RIGHTS AN INDI-
VIDUAL PROVIDER MAY  OTHERWISE  HAVE  PURSUANT  TO  THE  NATIONAL  LABOR
RELATIONS  ACT,  29 U.S.C. S 151, ET SEQ.; NEW YORK STATE PUBLIC EMPLOY-

A. 4239                             7

EES' FAIR EMPLOYMENT ACT (ARTICLE FOURTEEN OF THE CIVIL SERVICE LAW); OR
ANY OTHER STATUTE.
  S 5709. DEFINITIONS. IN THIS ARTICLE:
  (A)  "AUTHORIZED  THIRD PARTY" MEANS A PERSON AUTHORIZED BY THE PHYSI-
CIANS TO NEGOTIATE ON THEIR BEHALF WITH A HEALTH BENEFIT PLAN UNDER THIS
CHAPTER; AND
  (B) "HEALTH BENEFIT PLAN" MEANS A HEALTH CARE INSURER SUBJECT TO ARTI-
CLE THIRTY-TWO OR FORTY-THREE  OF  THIS  CHAPTER,  OR  ANY  ORGANIZATION
LICENSED UNDER ARTICLE FORTY-THREE OF THIS CHAPTER, BUT DOES NOT INCLUDE
A SELF-INSURED HEALTH BENEFIT PLAN.
  S 2. This act shall take effect on the one hundred eightieth day after
it shall have become a law.