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

                                 336--A

                       2015-2016 Regular Sessions

                          I N  A S S E M B L Y

                               (PREFILED)

                             January 7, 2015
                               ___________

Introduced  by  M.  of  A. GOTTFRIED, CAHILL, COLTON, MAGNARELLI, GALEF,
  PAULIN, SCHIMEL, LIFTON, CUSICK, O'DONNELL,  JAFFEE,  PERRY,  RUSSELL,
  MARKEY,   BRONSON,   ROSENTHAL,  LAVINE,  THIELE,  BENEDETTO,  TITONE,
  PEOPLES-STOKES,  GUNTHER,  WEPRIN,  ABINANTI,  ENGLEBRIGHT,   ROBERTS,
  BROOK-KRASNY, ROBINSON, SKOUFIS, OTIS, AUBRY, WRIGHT, STIRPE, BORELLI,
  CRESPO, STECK, CLARK -- Multi-Sponsored by -- M. of A. ABBATE, ARROYO,
  BRAUNSTEIN,  BRENNAN,  BUCHWALD,  COOK,  CYMBROWITZ,  DINOWITZ,  FAHY,
  GLICK, HIKIND,  HOOPER,  LENTOL,  LOPEZ,  LUPARDO,  LUPINACCI,  MAGEE,
  MALLIOTAKIS, McDONALD, MONTESANO, MOYA, ORTIZ, PRETLOW, RAIA, SEPULVE-
  DA,  WEINSTEIN -- read once and referred to the Committee on Health --
  reported and referred to the Committee on Ways and Means --  committee
  discharged, bill amended, ordered reprinted as amended and recommitted
  to said committee

AN  ACT  to amend the public health law, in relation to requirements for
  collective negotiations by health care providers with  certain  health
  benefit plans

  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  system  of  collective  action on behalf of health care
providers. Consequently, the legislature finds it appropriate and neces-
sary to displace competition with  regulation  of  health  plan-provider
agreements and authorize collective negotiations on the terms and condi-
tions  of  the  relationship  between  health care plans and health care

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

                                                           LBD02700-04-5

A. 336--A                           2

providers so the imbalances between the two will not result  in  adverse
conditions  of  health  care.  This  act  is not intended to apply to or
affect in any respect collective bargaining  relationships  which  arise
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, 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 HEALTH CARE PROVIDER OR HEALTH CARE PROVIDERS TO GAIN COMPLI-
ANCE WITH DEMANDS MADE ON A HEALTH CARE PLAN.
  5. "SUBSTANTIAL MARKET SHARE IN A BUSINESS LINE" EXISTS  IF  A  HEALTH
CARE  PLAN'S  MARKET SHARE OF A BUSINESS LINE WITHIN THE GEOGRAPHIC AREA
FOR WHICH A NEGOTIATION HAS BEEN APPROVED BY THE COMMISSIONER, 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
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  SIGNIFICANTLY  EXCEEDS  THE  COUNTERVAILING
MARKET SHARE OF THE PROVIDERS ACTING INDIVIDUALLY.
  6.  "HEALTH  CARE PROVIDER" MEANS A PERSON WHO IS LICENSED, CERTIFIED,
REGISTERED OR AUTHORIZED PURSUANT TO TITLE EIGHT OF  THE  EDUCATION  LAW
AND  WHO PRACTICES THAT PROFESSION AS A HEALTH CARE PROVIDER AS AN INDE-
PENDENT CONTRACTOR AND/OR WHO IS  AN  OWNER,  OFFICER,  SHAREHOLDER,  OR
PROPRIETOR  OF  A  HEALTH  CARE  PROVIDER,  OR AN ENTITY THAT EMPLOYS OR
UTILIZES HEALTH CARE PROVIDERS TO PROVIDE HEALTH CARE SERVICES,  INCLUD-

A. 336--A                           3

ING BUT NOT LIMITED TO A HOSPITAL LICENSED UNDER ARTICLE TWENTY-EIGHT OF
THIS   CHAPTER   OR  AN  ACCOUNTABLE  CARE  ORGANIZATION  UNDER  ARTICLE
TWENTY-NINE-E OF THIS CHAPTER.  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.
  S 4921. NON-FEE RELATED COLLECTIVE NEGOTIATION AUTHORIZED.  1.  HEALTH
CARE PROVIDERS PRACTICING WITHIN THE GEOGRAPHIC AREA FOR WHICH A NEGOTI-
ATION HAS BEEN APPROVED BY THE COMMISSIONER MAY MEET AND COMMUNICATE FOR
THE  PURPOSE  OF COLLECTIVELY NEGOTIATING THE FOLLOWING TERMS AND CONDI-
TIONS 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-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.
  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

A. 336--A                           4

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 ANY GEOGRAPHIC AREA
FOR WHICH A NEGOTIATION HAS BEEN APPROVED BY  THE  COMMISSIONER,  HEALTH
CARE  PROVIDERS  PRACTICING WITHIN THAT GEOGRAPHIC AREA MAY COLLECTIVELY
NEGOTIATE THE FOLLOWING TERMS AND CONDITIONS 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 GEOGRAPHIC AREA
FOR WHICH A NEGOTIATION HAS BEEN APPROVED BY  THE  COMMISSIONER  IF  THE
HEALTH  CARE  PLAN COVERS LESS THAN FIVE PERCENT OF THE ACTUAL NUMBER OF
COVERED LIVES OF THE HEALTH CARE PLAN IN THE 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.
  S 4924. REQUIREMENTS FOR HEALTH  CARE  PROVIDERS'  REPRESENTATIVE.  1.
BEFORE  ENGAGING  IN  COLLECTIVE NEGOTIATIONS WITH A HEALTH CARE PLAN ON

A. 336--A                           5

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 AND THE
ATTORNEY GENERAL, THE  COMMISSIONER  SHALL  APPROVE  OR  DISAPPROVE  THE
REPORT  NOT  LATER  THAN  THE  TWENTIETH DAY AFTER THE DATE ON WHICH THE
REPORT IS FILED. IF DISAPPROVED, THE COMMISSIONER SHALL FURNISH A  WRIT-
TEN  EXPLANATION OF ANY DEFICIENCIES, ALONG WITH A STATEMENT OF SPECIFIC
PROPOSALS FOR REMEDIAL MEASURES TO CURE THE DEFICIENCIES. IF THE COMMIS-
SIONER 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;

A. 336--A                           6

  (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.
  10. THE COMMISSIONER MAY COLLECT INFORMATION  FROM  OTHER  PERSONS  TO
ASSIST  IN  EVALUATING  THE  IMPACT  OF  THE PROPOSED ARRANGEMENT ON THE
HEALTH CARE MARKETPLACE. THE COMMISSIONER SHALL COLLECT INFORMATION FROM
HEALTH PLAN COMPANIES AND HEALTH CARE PROVIDERS OPERATING  IN  THE  SAME
GEOGRAPHIC AREA.
  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 - 003 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-
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 OF LAW UNDER THIS TITLE INCLUDING INFORMA-
TION 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.

A. 336--A                           7

  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. This act shall take effect on the one hundred twentieth day after
it shall have become a law; 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.