S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   4914
 
                        2017-2018 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 6, 2017
                                ___________
 
 Introduced  by  M.  of  A.  SCHIMMINGER -- read once and referred to the
   Committee on Health
 
 AN ACT to amend the public health law and the insurance law, in relation
   to improper practices relating to  staff  membership  or  professional
   privileges of a physician and board certification

   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subdivision 1 of section 2801-b of the public  health  law,
 as  amended  by  chapter  605 of the laws of 2008, is amended to read as
 follows:
   1. It shall be an improper practice for the governing body of a hospi-
 tal to refuse to act upon an application for staff membership or profes-
 sional privileges or to deny or withhold from a  physician,  podiatrist,
 optometrist,  dentist  or  licensed  midwife staff membership or profes-
 sional privileges in a hospital, or to exclude  or  expel  a  physician,
 podiatrist,  optometrist, dentist or licensed midwife from staff member-
 ship in a hospital or curtail, terminate or diminish in any way a physi-
 cian's, podiatrist's, optometrist's,  dentist's  or  licensed  midwife's
 professional  privileges  in  a  hospital,  without  stating the reasons
 therefor, or if the reasons stated are unrelated to standards of patient
 care, patient welfare, the objectives of the institution or the  charac-
 ter or competency of the applicant. It shall be an improper practice for
 a  governing  body of a hospital to refuse to act upon an application or
 to deny or to withhold staff membership or professional privileges to  a
 podiatrist  based solely upon a practitioner's category of licensure. IT
 SHALL BE AN IMPROPER PRACTICE FOR A GOVERNING  BODY  OF  A  HOSPITAL  TO
 REFUSE  TO  ACT  UPON  AN  APPLICATION  OR  TO DENY OR TO WITHHOLD STAFF
 MEMBERSHIP OR PROFESSIONAL PRIVILEGES OF A PHYSICIAN SOLELY BECAUSE SUCH
 PHYSICIAN IS NOT BOARD-CERTIFIED.

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD09068-01-7

              

 A. 4914                             2
 
   § 2. Paragraph (a) of subdivision 1 of section 4406-d  of  the  public
 health law, as amended by chapter 237 of the laws of 2009, is amended to
 read as follows:
   (a)  A  health  care  plan  shall,  upon  request,  make available and
 disclose to health care professionals written application procedures and
 minimum qualification requirements which a health care professional must
 meet in order to be considered by the health care plan. The  plan  shall
 consult with appropriately qualified health care professionals in devel-
 oping  its qualification requirements. A health care plan shall complete
 review of the health care professional's application to  participate  in
 the  in-network  portion  of  the  health care plan's network and shall,
 within ninety days of receiving a health care  professional's  completed
 application to participate in the health care plan's network, notify the
 health  care  professional as to: (i) whether he or she is credentialed;
 or (ii) whether additional time is necessary to make a determination  in
 spite  of the health care plan's best efforts or because of a failure of
 a third party to provide  necessary  documentation,  or  non-routine  or
 unusual  circumstances  require  additional  time  for  review.  In such
 instances where additional time is necessary because of a lack of neces-
 sary documentation, a health plan shall make every effort to obtain such
 information as soon as possible. A HEALTH CARE PLAN MAY  NOT  REFUSE  TO
 APPROVE AN APPLICATION FROM A PHYSICIAN TO PARTICIPATE IN THE IN-NETWORK
 PORTION  OF THE HEALTH CARE PLAN'S NETWORK SOLELY BECAUSE SUCH PHYSICIAN
 IS NOT BOARD-CERTIFIED.
   § 3. Paragraph (a) of subdivision 1 of section 4406-d  of  the  public
 health law, as amended by chapter 425 of the laws of 2016, is amended to
 read as follows:
   (a)  A  health  care  plan  shall,  upon  request,  make available and
 disclose to health care professionals written application procedures and
 minimum qualification requirements which a health care professional must
 meet in order to be considered by the health care plan. The  plan  shall
 consult with appropriately qualified health care professionals in devel-
 oping  its qualification requirements. A health care plan shall complete
 review of the health care professional's application to  participate  in
 the  in-network  portion  of  the  health care plan's network and shall,
 within sixty days of receiving a health  care  professional's  completed
 application to participate in the health care plan's network, notify the
 health  care  professional as to: (i) whether he or she is credentialed;
 or (ii) whether additional time is necessary  to  make  a  determination
 because  of  a  failure of a third party to provide necessary documenta-
 tion. In such instances where additional time is necessary because of  a
 lack  of  necessary documentation, a health plan shall make every effort
 to obtain such information as soon as possible and shall  make  a  final
 determination within twenty-one days of receiving the necessary documen-
 tation. A HEALTH CARE PLAN MAY NOT REFUSE TO APPROVE AN APPLICATION FROM
 A  PHYSICIAN TO PARTICIPATE IN THE IN-NETWORK PORTION OF THE HEALTH CARE
 PLAN'S NETWORK SOLELY BECAUSE SUCH PHYSICIAN IS NOT BOARD-CERTIFIED.
   § 4. Paragraph 1 of subsection (a) of section 4803  of  the  insurance
 law,  as  amended by chapter 237 of the laws of 2009, is amended to read
 as follows:
   (1) 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

 A. 4914                             3
 
 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) whether he or she is
 credentialed;  or  (B)  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 documentation, or non-
 routine or unusual circumstances require additional time for review.  In
 such instances where additional time is necessary because of a  lack  of
 necessary  documentation,  an  insurer shall make every effort to obtain
 such information as soon as possible.  AN  INSURER  MAY  NOT  REFUSE  TO
 APPROVE AN APPLICATION FROM A PHYSICIAN FOR PARTICIPATION IN THE IN-NET-
 WORK  PORTION  OF THE INSURER'S NETWORK SOLELY BECAUSE SUCH PHYSICIAN IS
 NOT BOARD-CERTIFIED.
   § 5. Paragraph 1 of subsection (a) of section 4803  of  the  insurance
 law,  as  amended by chapter 425 of the laws of 2016, is amended to read
 as follows:
   (1) 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 sixty days of receiving a health care professional's
 completed  application  to  participate  in  the insurer's network, will
 notify the health care professional as to: (A)  whether  he  or  she  is
 credentialed;  or  (B)  whether  additional  time is necessary to make a
 determination because of a failure of a third party to provide necessary
 documentation. In such instances  where  additional  time  is  necessary
 because  of  a  lack  of  necessary documentation, an insurer shall make
 every effort to obtain such information as soon as  possible  and  shall
 make  a  final  determination  within  twenty-one  days of receiving the
 necessary documentation. AN INSURER MAY NOT REFUSE TO APPROVE AN  APPLI-
 CATION  FROM  A PHYSICIAN FOR PARTICIPATION IN THE IN-NETWORK PORTION OF
 THE INSURER'S NETWORK SOLELY BECAUSE SUCH PHYSICIAN IS NOT  BOARD-CERTI-
 FIED.
   §  6.  This act shall take effect immediately; provided, however, that
 if chapter 425 of the laws of 2016 shall not have  taken  effect  on  or
 before  such  date  then  sections three and five of this act shall take
 effect on the same date and in the same manner as such  chapter  of  the
 laws of 2016 takes effect.

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  4914--A
 
                        2017-2018 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 6, 2017
                                ___________
 
 Introduced  by  M.  of  A.  SCHIMMINGER -- read once and referred to the
   Committee on Health -- recommitted  to  the  Committee  on  Health  in
   accordance  with Assembly Rule 3, sec. 2 -- committee discharged, bill
   amended, ordered reprinted as amended and recommitted to said  commit-
   tee

 AN ACT to amend the public health law and the insurance law, in relation
   to  improper  practices  relating  to staff membership or professional
   privileges of a physician and board certification
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Subdivision 1 of section 2801-b of the public health law,
 as amended by chapter 605 of the laws of 2008, is  amended  to  read  as
 follows:
   1. It shall be an improper practice for the governing body of a hospi-
 tal to refuse to act upon an application for staff membership or profes-
 sional  privileges  or to deny or withhold from a physician, podiatrist,
 optometrist, dentist or licensed midwife  staff  membership  or  profes-
 sional  privileges  in  a  hospital, or to exclude or expel a physician,
 podiatrist, optometrist, dentist or licensed midwife from staff  member-
 ship in a hospital or curtail, terminate or diminish in any way a physi-
 cian's,  podiatrist's,  optometrist's,  dentist's  or licensed midwife's
 professional privileges in  a  hospital,  without  stating  the  reasons
 therefor, or if the reasons stated are unrelated to standards of patient
 care,  patient welfare, the objectives of the institution or the charac-
 ter or competency of the applicant. It shall be an improper practice for
 a governing body of a hospital to refuse to act upon an  application  or
 to  deny or to withhold staff membership or professional privileges to a
 podiatrist based solely upon a practitioner's category of licensure.  IT
 SHALL  BE  AN  IMPROPER  PRACTICE  FOR A GOVERNING BODY OF A HOSPITAL TO
 REFUSE TO ACT UPON AN APPLICATION  OR  TO  DENY  OR  TO  WITHHOLD  STAFF
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD09068-04-8
              

 A. 4914--A                          2
 
 MEMBERSHIP OR PROFESSIONAL PRIVILEGES OF A PHYSICIAN SOLELY BECAUSE SUCH
 PHYSICIAN IS NOT BOARD-CERTIFIED.
   §  2.  Paragraph  (a) of subdivision 1 of section 4406-d of the public
 health law, as amended by chapter 425 of the laws of 2016, is amended to
 read as follows:
   (a) A health  care  plan  shall,  upon  request,  make  available  and
 disclose to health care professionals written application procedures and
 minimum qualification requirements which a health care professional must
 meet  in  order to be considered by the health care plan. The plan shall
 consult with appropriately qualified health care professionals in devel-
 oping its qualification requirements. A health care plan shall  complete
 review  of  the health care professional's application to participate in
 the in-network portion of the health  care  plan's  network  and  shall,
 within  sixty  days  of receiving a health care professional's completed
 application to participate in the health care plan's network, notify the
 health care professional as to: (i) whether he or she  is  credentialed;
 or  (ii)  whether  additional  time is necessary to make a determination
 because of a failure of a third party to  provide  necessary  documenta-
 tion.  In such instances where additional time is necessary because of a
 lack of necessary documentation, a health plan shall make  every  effort
 to  obtain  such  information as soon as possible and shall make a final
 determination within twenty-one days of receiving the necessary documen-
 tation. A HEALTH CARE PLAN MAY NOT REFUSE TO APPROVE AN APPLICATION FROM
 A PHYSICIAN TO PARTICIPATE IN THE IN-NETWORK PORTION OF THE HEALTH  CARE
 PLAN'S NETWORK SOLELY BECAUSE SUCH PHYSICIAN IS NOT BOARD-CERTIFIED.
   §  3.  Paragraph  1 of subsection (a) of section 4803 of the insurance
 law, as amended by chapter 425 of the laws of 2016, is amended  to  read
 as follows:
   (1)  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 sixty days of receiving a health care professional's
 completed application to participate  in  the  insurer's  network,  will
 notify  the  health  care  professional  as to: (A) whether he or she is
 credentialed; or (B) whether additional time  is  necessary  to  make  a
 determination because of a failure of a third party to provide necessary
 documentation.  In  such  instances  where  additional time is necessary
 because of a lack of necessary  documentation,  an  insurer  shall  make
 every  effort  to  obtain such information as soon as possible and shall
 make a final determination  within  twenty-one  days  of  receiving  the
 necessary  documentation. AN INSURER MAY NOT REFUSE TO APPROVE AN APPLI-
 CATION FROM A PHYSICIAN FOR PARTICIPATION IN THE IN-NETWORK  PORTION  OF
 THE  INSURER'S NETWORK SOLELY BECAUSE SUCH PHYSICIAN IS NOT BOARD-CERTI-
 FIED.
   § 4. This act shall take effect immediately.