S T A T E O F N E W Y O R K
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4681
2019-2020 Regular Sessions
I N A S S E M B L Y
February 5, 2019
___________
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.
§ 5701. LEGISLATIVE FINDINGS. THE LEGISLATURE FINDS AND DECLARES THAT:
(A) UNDER THE MCCARRAN-FERGUSON ACT OF 1945, 15 U.S.C. § 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.
LBD04880-01-9
A. 4681 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 ARTICULATED
STATE POLICY AND ACTIVE SUPERVISION PROVIDED UNDER THIS ARTICLE.
§ 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;
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(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. 4681 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-
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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.
§ 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.
§ 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.
§ 5705. REGULATIONS. THE ATTORNEY GENERAL MAY PROMULGATE ANY RULES AND
REGULATIONS NECESSARY TO IMPLEMENT THIS ARTICLE.
§ 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.
§ 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.
§ 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. § 151, ET SEQ.; NEW YORK STATE PUBLIC EMPLOY-
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EES' FAIR EMPLOYMENT ACT (ARTICLE FOURTEEN OF THE CIVIL SERVICE LAW); OR
ANY OTHER STATUTE.
§ 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.
§ 2. This act shall take effect on the one hundred eightieth day after
it shall have become a law.