S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   3395
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 3, 2023
                                ___________
 
 Introduced  by  M.  of  A. PRETLOW, COLTON, WEPRIN, MAGNARELLI, BRONSON,
   L. ROSENTHAL, LAVINE, THIELE, BENEDETTO, PEOPLES-STOKES -- Multi-Spon-
   sored by -- M. of A. AUBRY, COOK, DINOWITZ, GLICK, LUPARDO, RA -- read
   once and referred to the Committee on Health
 
 AN ACT to amend the public health law, in relation to  requirements  for
   collective  negotiations  by health care providers with certain health
   benefit plans in certain counties, and providing  for  the  repeal  of
   such provisions upon expiration thereof
 
   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 demonstration to examine the risks and benefits associated
 with  a  system of collective action on behalf of health care providers.
 Consequently, the legislature finds it appropriate and necessary in  the
 demonstration  service  area  to displace competition with regulation of
 health plan-provider agreements and authorize collective negotiations on
 the terms and conditions 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
 involving health care providers as defined in section 4920 of the public
 health  law  or  rights  relating to collective bargaining arising under
 applicable federal or state collective bargaining statutes.
   § 2. Short title.  This act shall be known and may  be  cited  as  the
 "health care consumer and provider protection act".
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD08161-01-3
              

 A. 3395                             2
 
   §  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.
   § 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 IN THE DEMONSTRATION SERVICE AREA, 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  BODY OF WORKERS TO GAIN COMPLIANCE WITH DEMANDS MADE ON AN
 EMPLOYER.
   5. "SUBSTANTIAL MARKET SHARE IN A BUSINESS LINE" EXISTS  IF  A  HEALTH
 CARE  PLAN'S  MARKET  SHARE  OF A BUSINESS LINE WITHIN THE DEMONSTRATION
 SERVICE AREA AS APPROVED BY THE COMMISSIONER, IN CONSULTATION  WITH  THE
 SUPERINTENDENT  OF  FINANCIAL SERVICES, 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, IN CONSULTATION WITH
 THE SUPERINTENDENT OF FINANCIAL SERVICES, 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  SIGNIF-
 ICANTLY  EXCEEDS THE COUNTERVAILING MARKET SHARE OF THE PROVIDERS ACTING
 INDIVIDUALLY.
   6. "HEALTH CARE PROVIDER" MEANS A PERSON WHO IS  LICENSED,  CERTIFIED,
 OR REGISTERED PURSUANT TO TITLE EIGHT OF THE EDUCATION LAW AND WHO PRAC-
 TICES  AS A HEALTH CARE PROVIDER AS AN INDEPENDENT CONTRACTOR AND/OR WHO
 IS AN OWNER, OFFICER,  SHAREHOLDER,  OR  PROPRIETOR  OF  A  HEALTH  CARE
 PROVIDER  IN  THE  DEMONSTRATION  SERVICE AREA.   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.
 A. 3395                             3
 
   7.  "DEMONSTRATION SERVICE AREA" SHALL INCLUDE THE COUNTIES OF ALBANY,
 COLUMBIA, GREENE, ORANGE, RENSSELAER, SARATOGA, SCHENECTADY,  SCHOHARIE,
 ULSTER, WARREN AND WASHINGTON.
   §  4921.  NON-FEE RELATED COLLECTIVE NEGOTIATION AUTHORIZED. 1. HEALTH
 CARE PROVIDERS PRACTICING WITHIN THE DEMONSTRATION SERVICE AREA MAY MEET
 AND COMMUNICATE FOR THE  PURPOSE  OF  COLLECTIVELY  NEGOTIATING  WITH  A
 HEALTH  CARE  PLAN  THE  FOLLOWING  TERMS  AND  CONDITIONS  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-POCKET 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.
 A. 3395                             4
 
   § 4922. FEE RELATED COLLECTIVE NEGOTIATION. 1. IF THE HEALTH CARE PLAN
 HAS  SUBSTANTIAL  MARKET  SHARE  IN A BUSINESS LINE IN THE DEMONSTRATION
 SERVICE AREA, HEALTH CARE PROVIDERS PRACTICING WITHIN THE  DEMONSTRATION
 SERVICE  AREA  MAY COLLECTIVELY NEGOTIATE THE FOLLOWING TERMS AND CONDI-
 TIONS 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.
   § 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  DEMONSTRATION
 SERVICE  AREA OR PROPOSED SERVICE AREA OF A HEALTH CARE PLAN THAT COVERS
 LESS THAN FIVE PERCENT OF THE ACTUAL NUMBER  OF  COVERED  LIVES  OF  THE
 HEALTH CARE PLAN IN THE DEMONSTRATION SERVICE 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.
   § 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-
 A. 3395                             5
 
 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, THE
 COMMISSIONER SHALL APPROVE OR DISAPPROVE THE REPORT NOT LATER  THAN  THE
 TWENTIETH  DAY  AFTER  THE  DATE ON WHICH THE REPORT IS FILED. IF DISAP-
 PROVED, THE COMMISSIONER SHALL FURNISH  A  WRITTEN  EXPLANATION  OF  ANY
 DEFICIENCIES,  ALONG WITH A STATEMENT OF SPECIFIC PROPOSALS FOR REMEDIAL
 MEASURES TO CURE THE DEFICIENCIES. IF THE COMMISSIONER 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  QUALIFIED
 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;
 A. 3395                             6
 
   (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.   THE
 COMMISSIONER, AFTER CONSULTATION WITH THE  SUPERINTENDENT  OF  FINANCIAL
 SERVICES  SHALL  DISAPPROVE  THE  AGREEMENT  IF HE OR SHE FINDS THAT THE
 AGREEMENT WOULD RESULT IN A SIGNIFICANT INCREASE IN COSTS TO  THE  MEDI-
 CAID MANAGED CARE PROGRAM PURSUANT TO SECTION THREE HUNDRED SIXTY-FOUR-J
 OF  THE  SOCIAL SERVICES LAW, THE FAMILY HEALTH PLUS PROGRAM PURSUANT TO
 SECTION THREE HUNDRED SIXTY-NINE-GG OF THE SOCIAL SERVICES LAW,  OR  THE
 CHILD HEALTH PLUS PROGRAM PURSUANT TO SECTION TWENTY-FIVE HUNDRED ELEVEN
 OF THIS CHAPTER.
   10.  THE  COMMISSIONER  MAY COLLECT INFORMATION FROM THE DEPARTMENT OF
 FINANCIAL SERVICES AND OTHER PERSONS TO ASSIST IN EVALUATING THE  IMPACT
 OF  THE PROPOSED ARRANGEMENT ON THE HEALTH CARE MARKETPLACE. THE COMMIS-
 SIONER SHALL COLLECT INFORMATION FROM HEALTH PLAN COMPANIES  AND  HEALTH
 CARE  PROVIDERS OPERATING IN THE SAME GEOGRAPHIC AREA AS THE HEALTH CARE
 COOPERATIVE.
   § 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.
   §  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 FOR  THE  NEW  YORK  STATE  DEPARTMENT  OF
 HEALTH FUND.
   §  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.
   § 4928. CONFIDENTIALITY. ALL REPORTS AND OTHER INFORMATION REQUIRED TO
 BE REPORTED TO THE DEPARTMENT UNDER  THIS  TITLE  INCLUDING  INFORMATION
 A. 3395                             7
 
 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.
   §  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.
   § 4. The department of health, in consultation with the department  of
 financial  services,  shall prepare or shall arrange for the preparation
 of a report on  the  implementation  of  the  demonstration  program  on
 collective  negotiation.  The report shall be submitted to the governor,
 the speaker of the assembly, the temporary president of the  senate  and
 the chairs of the senate and assembly health and insurance committees at
 least  four months prior to the expiration of this act. The report shall
 review the extent to which collective negotiations were conducted in the
 demonstration service area and shall examine whether and the  extent  to
 which  collective  negotiation contributed to the improvement of quality
 of care for patients,  enhanced  access  to  medically  necessary  care,
 reduced  unnecessary  health care expenditures, and was otherwise in the
 public interest. The  report  may  make  recommendations  regarding  the
 extension,  alteration and/or expansion of these provisions and make any
 other recommendations related to the implementation of collective  nego-
 tiation pursuant to this act.
   § 5. This act shall take effect on the one hundred twentieth day after
 it shall have become a law and shall expire and be deemed repealed three
 years  after it shall take effect.  Effective immediately, the addition,
 amendment and/or repeal of any rule  or  regulation  necessary  for  the
 implementation  of  this  act on its effective date are authorized to be
 made and completed on or before such effective date.