S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5140
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 7, 2019
                                ___________
 
 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 WHO WAS  PREVIOUSLY
 BOARD-CERTIFIED  AND  WHO  HAS  NOT MAINTAINED SUCH CERTIFICATION SOLELY
 BECAUSE SUCH PHYSICIAN IS NOT BOARD-CERTIFIED.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD09133-01-9
              

 A. 5140                             2
 
   § 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,  WHO  WAS PREVIOUSLY BOARD-CERTIFIED AND WHO HAS NOT MAIN-
 TAINED SUCH CERTIFICATION, 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, WHO WAS PREVIOUSLY BOARD-CERTIFIED AND WHO HAS
 NOT MAINTAINED SUCH CERTIFICATION, FOR PARTICIPATION IN  THE  IN-NETWORK
 PORTION  OF  THE  INSURER'S NETWORK SOLELY BECAUSE SUCH PHYSICIAN IS NOT
 BOARD-CERTIFIED.
   § 4. This act shall take effect immediately.