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

                                 1157--A

                       2015-2016 Regular Sessions

                            I N  S E N A T E

                             January 9, 2015
                               ___________

Introduced  by  Sens.  HANNON,  AVELLA,  DeFRANCISCO, ESPAILLAT, LARKIN,
  MURPHY -- read twice and ordered  printed,  and  when  printed  to  be
  committed  to  the Committee on Health -- reported favorably from said
  committee and committed to  the  Committee  on  Finance  --  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
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:

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD02700-05-5
              

S. 1157--A                          2

                                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-
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-

S. 1157--A                          3

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
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:

S. 1157--A                          4

  (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
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

S. 1157--A                          5

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;
  (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

S. 1157--A                          6

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.
  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

S. 1157--A                          7

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.