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

                                  3563

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                            January 28, 2013
                               ___________

Introduced  by  M. of A. PRETLOW, GOTTFRIED, CAHILL, COLTON, MAGNARELLI,
  GALEF, PAULIN, SCHIMEL, LIFTON,  CUSICK,  O'DONNELL,  RIVERA,  JAFFEE,
  WEISENBERG,  PERRY,  RUSSELL,  MARKEY,  BRONSON,  ROSENTHAL,  KELLNER,
  LAVINE, THIELE, BENEDETTO, TITONE, BOYLAND,  PEOPLES-STOKES,  GUNTHER,
  WEPRIN,  ABINANTI,  ENGLEBRIGHT, ROBERTS, MAISEL -- Multi-Sponsored by
  -- M. of A. ABBATE, AUBRY, BRENNAN, COOK, CYMBROWITZ, DINOWITZ, GLICK,
  HEASTIE, HIKIND, HOOPER, JACOBS, LENTOL, V. LOPEZ, LOSQUADRO, LUPARDO,
  MAGEE, MALLIOTAKIS, MILLMAN, MONTESANO, ORTIZ, RA, RAIA,  SCARBOROUGH,
  SWEENEY,  WEINSTEIN, WRIGHT -- read once and referred to the Committee
  on Health

AN ACT to amend the public health law, in relation to  requirements  for
  collective  negotiations  by health care providers with certain health
  benefit plans in certain counties, and providing  for  the  repeal  of
  such provisions upon the expiration thereof

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

  Section 1. Statement of legislative intent. The legislature finds that
collective negotiation by competing health care providers for the  terms
and  conditions  of contracts with health plans can result in beneficial
results  for  health  care  consumers.  The  legislature  further  finds
instances  where  health plans dominate the market to such a degree that
fair and adequate negotiations between health  care  providers  and  the
plans are adversely affected, so that it is necessary and appropriate to
provide for a demonstration to examine the risks and benefits associated
with  a  system of collective action on behalf of health care providers.
Consequently, the legislature finds it appropriate and necessary in  the
demonstration  service  area  to displace competition with regulation of
health plan-provider agreements and authorize collective negotiations on
the terms and conditions of the relationship between health  care  plans
and  health  care  providers  so the imbalances between the two will not
result in adverse conditions of health care. This act is not intended to

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD02579-02-3
              

A. 3563                             2

apply to or affect in any respect  collective  bargaining  relationships
involving health care providers as defined in section 4920 of the public
health  law  or  rights  relating to collective bargaining arising under
applicable federal or state collective bargaining statutes.
  S  2.  This  act  shall  be known and may be cited as the "health care
consumer and provider protection act".
  S 3. Article 49 of the public health law is amended by  adding  a  new
title III to read as follows:
                                TITLE III
                 COLLECTIVE NEGOTIATIONS BY HEALTH CARE
                    PROVIDERS WITH HEALTH CARE PLANS
SECTION 4920. DEFINITIONS.
        4921. NON-FEE RELATED COLLECTIVE NEGOTIATION AUTHORIZED.
        4922. FEE RELATED COLLECTIVE NEGOTIATION.
        4923. COLLECTIVE NEGOTIATION REQUIREMENTS.
        4924. REQUIREMENTS FOR HEALTH CARE PROVIDERS' REPRESENTATIVE.
        4925. CERTAIN COLLECTIVE ACTION PROHIBITED.
        4926. FEES.
        4927. MONITORING OF AGREEMENTS.
        4928. CONFIDENTIALITY.
        4929. SEVERABILITY AND CONSTRUCTION.
  S 4920. DEFINITIONS. FOR PURPOSES OF THIS TITLE:
  1.  "HEALTH  CARE  PLAN"  MEANS  AN  ENTITY  (OTHER THAN A HEALTH CARE
PROVIDER) THAT APPROVES, PROVIDES, ARRANGES FOR, OR PAYS FOR HEALTH CARE
SERVICES IN THE DEMONSTRATION SERVICE AREA, INCLUDING  BUT  NOT  LIMITED
TO:
  (A)  A  HEALTH  MAINTENANCE  ORGANIZATION LICENSED PURSUANT TO ARTICLE
FORTY-THREE OF THE  INSURANCE  LAW  OR  CERTIFIED  PURSUANT  TO  ARTICLE
FORTY-FOUR OF THIS CHAPTER;
  (B) ANY OTHER ORGANIZATION CERTIFIED PURSUANT TO ARTICLE FORTY-FOUR OF
THIS CHAPTER; OR
  (C) AN INSURER OR CORPORATION SUBJECT TO THE INSURANCE LAW.
  2.  "PERSON"  MEANS  AN  INDIVIDUAL,  ASSOCIATION, CORPORATION, OR ANY
OTHER LEGAL ENTITY.
  3. "HEALTH CARE PROVIDERS' REPRESENTATIVE" MEANS A THIRD PARTY WHO  IS
AUTHORIZED  BY  HEALTH  CARE PROVIDERS TO NEGOTIATE ON THEIR BEHALF WITH
HEALTH CARE PLANS OVER CONTRACTUAL TERMS AND CONDITIONS AFFECTING  THOSE
HEALTH CARE PROVIDERS.
  4. "STRIKE" MEANS A WORK STOPPAGE IN PART OR IN WHOLE, DIRECT OR INDI-
RECT,  BY  A  BODY OF WORKERS TO GAIN COMPLIANCE WITH DEMANDS MADE ON AN
EMPLOYER.
  5. "SUBSTANTIAL MARKET SHARE IN A BUSINESS LINE" EXISTS  IF  A  HEALTH
CARE  PLAN'S  MARKET  SHARE  OF A BUSINESS LINE WITHIN THE DEMONSTRATION
SERVICE AREA AS APPROVED BY THE COMMISSIONER, IN CONSULTATION  WITH  THE
SUPERINTENDENT  OF  FINANCIAL SERVICES, ALONE OR IN COMBINATION WITH THE
MARKET SHARES OF AFFILIATES, EXCEEDS EITHER TEN  PERCENT  OF  THE  TOTAL
NUMBER  OF  COVERED LIVES IN THAT SERVICE AREA FOR SUCH BUSINESS LINE OR
TWENTY-FIVE THOUSAND LIVES, OR IF THE COMMISSIONER, IN CONSULTATION WITH
THE SUPERINTENDENT OF FINANCIAL SERVICES, DETERMINES THE MARKET SHARE OF
THE INSURER IN THE RELEVANT INSURANCE PRODUCT AND GEOGRAPHIC MARKETS FOR
THE SERVICES OF THE PROVIDERS SEEKING TO COLLECTIVELY NEGOTIATE  SIGNIF-
ICANTLY  EXCEEDS THE COUNTERVAILING MARKET SHARE OF THE PROVIDERS ACTING
INDIVIDUALLY.
  6. "HEALTH CARE PROVIDER" MEANS A PERSON WHO IS  LICENSED,  CERTIFIED,
OR REGISTERED PURSUANT TO TITLE EIGHT OF THE EDUCATION LAW AND WHO PRAC-
TICES  AS A HEALTH CARE PROVIDER AS AN INDEPENDENT CONTRACTOR AND/OR WHO

A. 3563                             3

IS AN OWNER, OFFICER,  SHAREHOLDER,  OR  PROPRIETOR  OF  A  HEALTH  CARE
PROVIDER  IN  THE  DEMONSTRATION  SERVICE AREA.   A HEALTH CARE PROVIDER
UNDER TITLE EIGHT OF THE EDUCATION LAW WHO PRACTICES AS AN EMPLOYEE OF A
HEALTH  CARE  PROVIDER  SHALL  NOT  BE DEEMED A HEALTH CARE PROVIDER FOR
PURPOSES OF THIS TITLE.
  7. "DEMONSTRATION SERVICE AREA" SHALL INCLUDE THE COUNTIES OF  ALBANY,
COLUMBIA,  GREENE, ORANGE, RENSSELAER, SARATOGA, SCHENECTADY, SCHOHARIE,
ULSTER, WARREN AND WASHINGTON.
  S 4921. NON-FEE RELATED COLLECTIVE NEGOTIATION AUTHORIZED.  1.  HEALTH
CARE PROVIDERS PRACTICING WITHIN THE DEMONSTRATION SERVICE AREA MAY MEET
AND  COMMUNICATE  FOR  THE  PURPOSE  OF  COLLECTIVELY NEGOTIATING WITH A
HEALTH  CARE  PLAN  THE  FOLLOWING  TERMS  AND  CONDITIONS  OF  PROVIDER
CONTRACTS WITH THE HEALTH CARE PLAN:
  (A)  THE DETAILS OF THE UTILIZATION REVIEW PLAN AS DEFINED PURSUANT TO
SUBDIVISION TEN OF  SECTION  FORTY-NINE  HUNDRED  OF  THIS  ARTICLE  AND
SUBSECTION  (J)  OF  SECTION FOUR THOUSAND NINE HUNDRED OF THE INSURANCE
LAW;
  (B) COVERAGE  PROVISIONS;  HEALTH  CARE  BENEFITS;  BENEFIT  MAXIMUMS,
INCLUDING BENEFIT LIMITATIONS; AND EXCLUSIONS OF COVERAGE;
  (C) THE DEFINITION OF MEDICAL NECESSITY;
  (D)  THE  CLINICAL  PRACTICE GUIDELINES USED TO MAKE MEDICAL NECESSITY
AND UTILIZATION REVIEW DETERMINATIONS;
  (E) PREVENTIVE CARE AND OTHER MEDICAL MANAGEMENT PRACTICES;
  (F) DRUG FORMULARIES AND  STANDARDS  AND  PROCEDURES  FOR  PRESCRIBING
OFF-FORMULARY DRUGS;
  (G) RESPECTIVE PHYSICIAN LIABILITY FOR THE TREATMENT OR LACK OF TREAT-
MENT OF COVERED PERSONS;
  (H)  THE  DETAILS  OF HEALTH CARE PLAN RISK TRANSFER ARRANGEMENTS WITH
PROVIDERS;
  (I) PLAN ADMINISTRATIVE PROCEDURES, INCLUDING METHODS  AND  TIMING  OF
HEALTH CARE PROVIDER PAYMENT FOR SERVICES;
  (J)  PROCEDURES  TO BE UTILIZED TO RESOLVE DISPUTES BETWEEN THE HEALTH
CARE PLAN AND HEALTH CARE PROVIDERS;
  (K) PATIENT REFERRAL PROCEDURES INCLUDING, BUT NOT LIMITED  TO,  THOSE
APPLICABLE TO OUT-OF-POCKET NETWORK REFERRALS;
  (L) THE FORMULATION AND APPLICATION OF HEALTH CARE PROVIDER REIMBURSE-
MENT PROCEDURES;
  (M) QUALITY ASSURANCE PROGRAMS;
  (N)  THE  PROCESS  FOR  RENDERING  UTILIZATION  REVIEW  DETERMINATIONS
INCLUDING: ESTABLISHMENT OF A PROCESS FOR RENDERING  UTILIZATION  REVIEW
DETERMINATIONS WHICH SHALL, AT A MINIMUM, INCLUDE: WRITTEN PROCEDURES TO
ASSURE  THAT UTILIZATION REVIEWS AND DETERMINATIONS ARE CONDUCTED WITHIN
THE TIMEFRAMES ESTABLISHED IN THIS  ARTICLE;  PROCEDURES  TO  NOTIFY  AN
ENROLLEE,  AN  ENROLLEE'S  DESIGNEE  AND/OR  AN  ENROLLEE'S  HEALTH CARE
PROVIDER OF ADVERSE DETERMINATIONS; AND PROCEDURES FOR APPEAL OF ADVERSE
DETERMINATIONS, INCLUDING THE  ESTABLISHMENT  OF  AN  EXPEDITED  APPEALS
PROCESS  FOR DENIALS OF CONTINUED INPATIENT CARE OR WHERE THERE IS IMMI-
NENT OR SERIOUS THREAT TO THE HEALTH OF THE ENROLLEE; AND
  (O) HEALTH CARE PROVIDER SELECTION AND TERMINATION  CRITERIA  USED  BY
THE HEALTH CARE PLAN.
  2. NOTHING IN THIS SECTION SHALL BE CONSTRUED TO ALLOW OR AUTHORIZE AN
ALTERATION  OF  THE TERMS OF THE INTERNAL AND EXTERNAL REVIEW PROCEDURES
SET FORTH IN LAW.
  3. NOTHING IN THIS SECTION SHALL BE CONSTRUED TO ALLOW A STRIKE  OF  A
HEALTH  CARE  PLAN  BY  HEALTH  CARE PROVIDERS OR PLANS AS OTHERWISE SET
FORTH IN THE LAWS OF THIS STATE.

A. 3563                             4

  4. NOTHING IN THIS SECTION SHALL BE CONSTRUED TO  ALLOW  OR  AUTHORIZE
TERMS OR CONDITIONS WHICH WOULD IMPEDE THE ABILITY OF A HEALTH CARE PLAN
TO  OBTAIN OR RETAIN ACCREDITATION BY THE NATIONAL COMMITTEE FOR QUALITY
ASSURANCE OR A SIMILAR BODY.
  S 4922. FEE RELATED COLLECTIVE NEGOTIATION. 1. IF THE HEALTH CARE PLAN
HAS  SUBSTANTIAL  MARKET  SHARE  IN A BUSINESS LINE IN THE DEMONSTRATION
SERVICE AREA, HEALTH CARE PROVIDERS PRACTICING WITHIN THE  DEMONSTRATION
SERVICE  AREA  MAY COLLECTIVELY NEGOTIATE THE FOLLOWING TERMS AND CONDI-
TIONS RELATING TO THAT BUSINESS LINE WITH THE HEALTH CARE PLAN:
  (A) THE FEES ASSESSED BY THE HEALTH CARE PLAN FOR SERVICES,  INCLUDING
FEES ESTABLISHED THROUGH THE APPLICATION OF REIMBURSEMENT PROCEDURES;
  (B)  THE  CONVERSION  FACTORS  USED  BY  THE  HEALTH  CARE  PLAN  IN A
RESOURCE-BASED RELATIVE VALUE SCALE REIMBURSEMENT METHODOLOGY  OR  OTHER
SIMILAR  METHODOLOGY; PROVIDED THE SAME ARE NOT OTHERWISE ESTABLISHED BY
STATE OR FEDERAL LAW OR REGULATION;
  (C) THE AMOUNT OF ANY DISCOUNT GRANTED BY THE HEALTH CARE PLAN ON  THE
FEE OF HEALTH CARE SERVICES TO BE RENDERED BY HEALTH CARE PROVIDERS;
  (D)  THE  DOLLAR  AMOUNT  OF  CAPITATION  OR  FIXED PAYMENT FOR HEALTH
SERVICES RENDERED BY HEALTH CARE PROVIDERS TO HEALTH  CARE  PLAN  ENROL-
LEES;
  (E)  THE  PROCEDURE CODE OR OTHER DESCRIPTION OF A HEALTH CARE SERVICE
COVERED BY A PAYMENT AND  THE  APPROPRIATE  GROUPING  OF  THE  PROCEDURE
CODES; OR
  (F) THE AMOUNT OF ANY OTHER COMPONENT OF THE REIMBURSEMENT METHODOLOGY
FOR A HEALTH CARE SERVICE.
  2.  NOTHING  HEREIN  SHALL BE DEEMED TO AFFECT OR LIMIT THE RIGHT OF A
HEALTH CARE PROVIDER OR GROUP OF HEALTH CARE PROVIDERS  TO  COLLECTIVELY
PETITION A GOVERNMENT ENTITY FOR A CHANGE IN A LAW, RULE, OR REGULATION.
  S 4923. COLLECTIVE NEGOTIATION REQUIREMENTS. 1. COLLECTIVE NEGOTIATION
RIGHTS GRANTED BY THIS TITLE MUST CONFORM TO THE FOLLOWING REQUIREMENTS:
  (A)  HEALTH  CARE  PROVIDERS  MAY  COMMUNICATE  WITH OTHER HEALTH CARE
PROVIDERS REGARDING THE CONTRACTUAL TERMS AND CONDITIONS TO  BE  NEGOTI-
ATED WITH A HEALTH CARE PLAN;
  (B)  HEALTH CARE PROVIDERS MAY COMMUNICATE WITH HEALTH CARE PROVIDERS'
REPRESENTATIVES;
  (C) A HEALTH CARE PROVIDERS' REPRESENTATIVE IS THE ONLY PARTY  AUTHOR-
IZED  TO  NEGOTIATE  WITH HEALTH CARE PLANS ON BEHALF OF THE HEALTH CARE
PROVIDERS AS A GROUP;
  (D) A HEALTH CARE PROVIDER CAN BE BOUND BY THE  TERMS  AND  CONDITIONS
NEGOTIATED BY THE HEALTH CARE PROVIDERS' REPRESENTATIVES; AND
  (E)  IN  COMMUNICATING  OR NEGOTIATING WITH THE HEALTH CARE PROVIDERS'
REPRESENTATIVE, A HEALTH CARE PLAN IS ENTITLED TO CONTRACT WITH OR OFFER
DIFFERENT CONTRACT TERMS AND CONDITIONS TO INDIVIDUAL  COMPETING  HEALTH
CARE PROVIDERS.
  2. A HEALTH CARE PROVIDERS' REPRESENTATIVE MAY NOT REPRESENT MORE THAN
THIRTY PERCENT OF THE MARKET OF HEALTH CARE PROVIDERS OR OF A PARTICULAR
HEALTH  CARE  PROVIDER TYPE OR SPECIALTY PRACTICING IN THE DEMONSTRATION
SERVICE AREA OR PROPOSED SERVICE AREA OF A HEALTH CARE PLAN THAT  COVERS
LESS  THAN  FIVE  PERCENT  OF  THE ACTUAL NUMBER OF COVERED LIVES OF THE
HEALTH CARE PLAN IN THE DEMONSTRATION SERVICE AREA, AS DETERMINED BY THE
DEPARTMENT.
  3. NOTHING IN THIS SECTION SHALL BE CONSTRUED TO  PROHIBIT  COLLECTIVE
ACTION  ON  THE  PART  OF  ANY HEALTH CARE PROVIDER WHO IS A MEMBER OF A
COLLECTIVE BARGAINING UNIT RECOGNIZED PURSUANT  TO  THE  NATIONAL  LABOR
RELATIONS ACT.

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  S  4924.  REQUIREMENTS  FOR  HEALTH CARE PROVIDERS' REPRESENTATIVE. 1.
BEFORE ENGAGING IN COLLECTIVE NEGOTIATIONS WITH A HEALTH  CARE  PLAN  ON
BEHALF OF HEALTH CARE PROVIDERS, A HEALTH CARE PROVIDERS' REPRESENTATIVE
SHALL  FILE  WITH  THE  COMMISSIONER,  IN  THE  MANNER PRESCRIBED BY THE
COMMISSIONER,  INFORMATION IDENTIFYING THE REPRESENTATIVE, THE REPRESEN-
TATIVE'S PLAN OF  OPERATION,  AND  THE  REPRESENTATIVE'S  PROCEDURES  TO
ENSURE COMPLIANCE WITH THIS TITLE.
  2.  BEFORE  ENGAGING  IN  THE COLLECTIVE NEGOTIATIONS, THE HEALTH CARE
PROVIDERS' REPRESENTATIVE SHALL ALSO SUBMIT TO THE COMMISSIONER FOR  THE
COMMISSIONER'S APPROVAL A REPORT IDENTIFYING THE PROPOSED SUBJECT MATTER
OF  THE  NEGOTIATIONS  OR  DISCUSSIONS WITH THE HEALTH CARE PLAN AND THE
EFFICIENCIES OR BENEFITS EXPECTED TO BE  ACHIEVED  THROUGH  THE  NEGOTI-
ATIONS  FOR  BOTH  THE  PROVIDERS  AND CONSUMERS OF HEALTH SERVICES. THE
COMMISSIONER SHALL NOT  APPROVE  THE  REPORT  IF  THE  COMMISSIONER,  IN
CONSULTATION  WITH  THE SUPERINTENDENT OF FINANCIAL SERVICES, DETERMINES
THAT THE PROPOSED NEGOTIATIONS WOULD EXCEED THE AUTHORITY GRANTED  UNDER
THIS TITLE.
  3.  THE  REPRESENTATIVE SHALL SUPPLEMENT THE INFORMATION IN THE REPORT
ON A REGULAR BASIS OR AS NEW INFORMATION BECOMES  AVAILABLE,  INDICATING
THAT  THE  SUBJECT  MATTER OF THE NEGOTIATIONS WITH THE HEALTH CARE PLAN
HAS CHANGED OR WILL CHANGE. IN NO EVENT SHALL THE REPORT  BE  LESS  THAN
EVERY THIRTY DAYS.
  4.  WITH  THE  ADVICE OF THE SUPERINTENDENT OF FINANCIAL SERVICES, THE
COMMISSIONER SHALL APPROVE OR DISAPPROVE THE REPORT NOT LATER  THAN  THE
TWENTIETH  DAY  AFTER  THE  DATE ON WHICH THE REPORT IS FILED. IF DISAP-
PROVED, THE COMMISSIONER SHALL FURNISH  A  WRITTEN  EXPLANATION  OF  ANY
DEFICIENCIES,  ALONG WITH A STATEMENT OF SPECIFIC PROPOSALS FOR REMEDIAL
MEASURES TO CURE THE DEFICIENCIES. IF THE COMMISSIONER DOES NOT  SO  ACT
WITHIN THE TWENTY DAYS, THE REPORT SHALL BE DEEMED APPROVED.
  5.  A PERSON WHO ACTS AS A HEALTH CARE PROVIDERS' REPRESENTATIVE WITH-
OUT THE APPROVAL OF THE COMMISSIONER UNDER THIS SECTION SHALL BE  DEEMED
TO BE ACTING OUTSIDE THE AUTHORITY GRANTED UNDER THIS TITLE.
  6.  BEFORE  REPORTING  THE  RESULTS OF NEGOTIATIONS WITH A HEALTH CARE
PLAN OR PROVIDING TO THE AFFECTED HEALTH CARE PROVIDERS AN EVALUATION OF
ANY OFFER MADE BY A HEALTH CARE PLAN, THE HEALTH CARE PROVIDERS'  REPRE-
SENTATIVE SHALL FURNISH FOR APPROVAL BY THE COMMISSIONER, BEFORE DISSEM-
INATION TO THE HEALTH CARE PROVIDERS, A COPY OF ALL COMMUNICATIONS TO BE
MADE  TO THE HEALTH CARE PROVIDERS RELATED TO NEGOTIATIONS, DISCUSSIONS,
AND OFFERS MADE BY THE HEALTH CARE PLAN.
  7. A HEALTH CARE PROVIDERS' REPRESENTATIVE   SHALL REPORT THE  END  OF
NEGOTIATIONS TO THE COMMISSIONER NOT LATER THAN THE FOURTEENTH DAY AFTER
THE DATE OF A HEALTH CARE PLAN DECISION DECLINING NEGOTIATION, CANCELING
NEGOTIATIONS,  OR  FAILING  TO RESPOND TO A REQUEST FOR NEGOTIATION.  IN
SUCH INSTANCES, A HEALTH  CARE  PROVIDERS'  REPRESENTATIVE  MAY  REQUEST
INTERVENTION  FROM  THE  COMMISSIONER TO REQUIRE THE HEALTH CARE PLAN TO
PARTICIPATE IN THE NEGOTIATION PURSUANT TO  SUBDIVISION  EIGHT  OF  THIS
SECTION.
  8. (A) IN THE EVENT THE COMMISSIONER DETERMINES THAT AN IMPASSE EXISTS
IN  THE  NEGOTIATIONS,  OR  IN  THE EVENT A HEALTH CARE PLAN DECLINES TO
NEGOTIATE, CANCELS NEGOTIATIONS OR FAILS TO RESPOND  TO  A  REQUEST  FOR
NEGOTIATION, THE COMMISSIONER SHALL RENDER ASSISTANCE AS FOLLOWS:
  (1)  TO  ASSIST  THE  PARTIES  TO EFFECT A VOLUNTARY RESOLUTION OF THE
NEGOTIATIONS, THE COMMISSIONER SHALL APPOINT A MEDIATOR FROM A  LIST  OF
QUALIFIED  PERSONS  MAINTAINED  BY  THE COMMISSIONER. IF THE MEDIATOR IS
SUCCESSFUL IN RESOLVING THE IMPASSE, THEN  THE  HEALTH  CARE  PROVIDERS'
REPRESENTATIVE SHALL PROCEED AS SET FORTH IN THIS ARTICLE;

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  (2)  IF  AN  IMPASSE  CONTINUES,  THE  COMMISSIONER  SHALL  APPOINT  A
FACT-FINDING BOARD OF NOT MORE THAN THREE MEMBERS FROM A LIST OF  QUALI-
FIED  PERSONS  MAINTAINED  BY THE COMMISSIONER, WHICH FACT-FINDING BOARD
SHALL HAVE, IN ADDITION TO THE POWERS DELEGATED TO IT BY THE BOARD,  THE
POWER TO MAKE RECOMMENDATIONS FOR THE RESOLUTION OF THE DISPUTE;
  (B) THE FACT-FINDING BOARD, ACTING BY A MAJORITY OF ITS MEMBERS, SHALL
TRANSMIT  ITS FINDINGS OF FACT AND RECOMMENDATIONS FOR RESOLUTION OF THE
DISPUTE TO THE COMMISSIONER, AND MAY THEREAFTER ASSIST  THE  PARTIES  TO
EFFECT  A  VOLUNTARY  RESOLUTION  OF THE DISPUTE. THE FACT-FINDING BOARD
SHALL ALSO SHARE ITS FINDINGS  OF  FACT  AND  RECOMMENDATIONS  WITH  THE
HEALTH CARE PROVIDERS' REPRESENTATIVE AND THE HEALTH CARE PLAN. IF WITH-
IN  TWENTY  DAYS AFTER THE SUBMISSION OF THE FINDINGS OF FACT AND RECOM-
MENDATIONS, THE IMPASSE CONTINUES, THE COMMISSIONER SHALL ORDER A RESOL-
UTION  TO  THE  NEGOTIATIONS  BASED  UPON  THE  FINDINGS  OF  FACT   AND
RECOMMENDATIONS SUBMITTED BY THE FACT-FINDING BOARD.
  9.  ANY  PROPOSED AGREEMENT BETWEEN HEALTH CARE PROVIDERS AND A HEALTH
CARE PLAN NEGOTIATED PURSUANT TO THIS TITLE SHALL BE  SUBMITTED  TO  THE
COMMISSIONER  FOR  FINAL  APPROVAL.  THE  COMMISSIONER  SHALL APPROVE OR
DISAPPROVE THE AGREEMENT WITHIN SIXTY DAYS  OF  SUCH  SUBMISSION.    THE
COMMISSIONER,  AFTER  CONSULTATION  WITH THE SUPERINTENDENT OF FINANCIAL
SERVICES SHALL DISAPPROVE THE AGREEMENT IF HE  OR  SHE  FINDS  THAT  THE
AGREEMENT  WOULD  RESULT IN A SIGNIFICANT INCREASE IN COSTS TO THE MEDI-
CAID MANAGED CARE PROGRAM PURSUANT TO SECTION THREE HUNDRED SIXTY-FOUR-J
OF THE SOCIAL SERVICES LAW, THE FAMILY HEALTH PLUS PROGRAM  PURSUANT  TO
SECTION  THREE  HUNDRED SIXTY-NINE-EE OF THE SOCIAL SERVICES LAW, OR THE
CHILD HEALTH PLUS PROGRAM PURSUANT TO SECTION TWENTY-FIVE HUNDRED ELEVEN
OF THE PUBLIC HEALTH LAW.
  10. THE COMMISSIONER MAY COLLECT INFORMATION FROM  THE  DEPARTMENT  OF
FINANCIAL  SERVICES AND OTHER PERSONS TO ASSIST IN EVALUATING THE IMPACT
OF THE PROPOSED ARRANGEMENT ON THE HEALTH CARE MARKETPLACE. THE  COMMIS-
SIONER  SHALL  COLLECT INFORMATION FROM HEALTH PLAN COMPANIES AND HEALTH
CARE PROVIDERS OPERATING IN THE SAME GEOGRAPHIC AREA AS THE HEALTH  CARE
COOPERATIVE.
  S  4925.  CERTAIN  COLLECTIVE  ACTION PROHIBITED. 1. THIS TITLE IS NOT
INTENDED TO AUTHORIZE COMPETING HEALTH CARE PROVIDERS TO ACT IN  CONCERT
IN  RESPONSE  TO A REPORT ISSUED BY THE HEALTH CARE PROVIDERS' REPRESEN-
TATIVE RELATED TO THE REPRESENTATIVE'S DISCUSSIONS OR NEGOTIATIONS  WITH
HEALTH CARE PLANS.
  2. NO HEALTH CARE PROVIDERS' REPRESENTATIVE SHALL NEGOTIATE ANY AGREE-
MENT  THAT  EXCLUDES,  LIMITS  THE PARTICIPATION OR REIMBURSEMENT OF, OR
OTHERWISE LIMITS THE SCOPE OF SERVICES TO BE PROVIDED BY ANY HEALTH CARE
PROVIDER OR GROUP OF HEALTH CARE PROVIDERS WITH RESPECT TO THE  PERFORM-
ANCE  OF  SERVICES  THAT  ARE WITHIN THE HEALTH CARE PROVIDER'S SCOPE OF
PRACTICE, LICENSE, REGISTRATION, OR CERTIFICATE.
  S 4926. FEES. EACH PERSON WHO ACTS AS THE REPRESENTATIVE OR  NEGOTIAT-
ING PARTIES UNDER THIS TITLE SHALL PAY TO THE DEPARTMENT A FEE TO ACT AS
A  REPRESENTATIVE.  THE COMMISSIONER, BY RULE, SHALL SET FEES IN AMOUNTS
DEEMED REASONABLE AND NECESSARY TO  COVER  THE  COSTS  INCURRED  BY  THE
DEPARTMENT  IN  ADMINISTERING  THIS  TITLE. ANY FEE COLLECTED UNDER THIS
SECTION SHALL BE DEPOSITED IN THE STATE TREASURY TO THE  CREDIT  OF  THE
GENERAL  FUND/STATE  OPERATIONS  FOR  THE  NEW  YORK STATE DEPARTMENT OF
HEALTH FUND.
  S 4927. MONITORING OF  AGREEMENTS.  THE  COMMISSIONER  SHALL  ACTIVELY
MONITOR  AGREEMENTS  APPROVED UNDER THIS TITLE TO ENSURE THAT THE AGREE-
MENT REMAINS  IN  COMPLIANCE  WITH  THE  CONDITIONS  OF  APPROVAL.  UPON
REQUEST, A HEALTH CARE PLAN OR HEALTH CARE PROVIDER SHALL PROVIDE INFOR-

A. 3563                             7

MATION  REGARDING  COMPLIANCE.  THE  COMMISSIONER MAY REVOKE AN APPROVAL
UPON A FINDING THAT THE AGREEMENT IS NOT IN SUBSTANTIAL COMPLIANCE  WITH
THE TERMS OF THE APPLICATION OR THE CONDITIONS OF APPROVAL.
  S 4928. CONFIDENTIALITY. ALL REPORTS AND OTHER INFORMATION REQUIRED TO
BE  REPORTED  TO  THE  DEPARTMENT UNDER THIS TITLE INCLUDING INFORMATION
OBTAINED BY THE COMMISSIONER PURSUANT  TO  SUBDIVISION  TEN  OF  SECTION
FORTY-NINE  HUNDRED  TWENTY-FOUR  OF  THIS TITLE SHALL NOT BE SUBJECT TO
DISCLOSURE UNDER ARTICLE SIX OF THE PUBLIC OFFICERS LAW OR ARTICLE THIR-
TY-ONE OF THE CIVIL PRACTICE LAW AND RULES.
  S 4929. SEVERABILITY AND CONSTRUCTION. THE PROVISIONS  OF  THIS  TITLE
SHALL  BE SEVERABLE, AND IF ANY COURT OF COMPETENT JURISDICTION DECLARES
ANY PHRASE, CLAUSE, SENTENCE OR PROVISION OF THIS TITLE TO  BE  INVALID,
OR  ITS  APPLICABILITY TO ANY GOVERNMENT, AGENCY, PERSON OR CIRCUMSTANCE
IS DECLARED INVALID, THE REMAINDER OF THIS TITLE AND ITS RELEVANT APPLI-
CABILITY SHALL NOT BE AFFECTED. THE PROVISIONS OF THIS  TITLE  SHALL  BE
LIBERALLY CONSTRUED TO GIVE EFFECT TO THE PURPOSES THEREOF.
  S  4. The department of health, in consultation with the department of
financial services, shall prepare or shall arrange for  the  preparation
of  a  report  on  the  implementation  of  the demonstration program on
collective negotiation. The report shall be submitted to  the  governor,
the  speaker  of the assembly, the temporary president of the senate and
the chairs of the senate and assembly health and insurance committees at
least four months prior to the expiration of this act. The report  shall
review the extent to which collective negotiations were conducted in the
demonstration  service  area and shall examine whether and the extent to
which collective negotiation contributed to the improvement  of  quality
of  care  for  patients,  enhanced  access  to medically necessary care,
reduced unnecessary health care expenditures, and was otherwise  in  the
public  interest.  The  report  may  make  recommendations regarding the
extension, alteration and/or expansion of these provisions and make  any
other  recommendations related to the implementation of collective nego-
tiation pursuant to this act.
  S 5. This act shall take effect on the one hundred twentieth day after
it shall have become a law and shall expire and be deemed repealed three
years after it shall take effect;  provided  that  the  commissioner  of
health is authorized to promulgate any and all rules and regulations and
take any other measures necessary to implement this act on its effective
date on or before such date.