NY State Senate Bill 2023-S1727A

Senate Bill S1727A

2023-2024 Legislative Session

Relates to improper practices relating to staff membership or professional privileges of a physician and such physician's board certification

download bill text pdf

Current Bill Status - In Senate Committee Rules Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Actions

View Actions

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jun 07, 2024	committed to rules
May 23, 2024	advanced to third reading
May 22, 2024	2nd report cal.
May 21, 2024	1st report cal.1344
May 07, 2024	print number 1727a
May 07, 2024	amend and recommit to health
Jan 03, 2024	referred to health
Jan 13, 2023	referred to health

Votes

- May 21, 2024 - Health Committee Vote
  S1727A
  
  9
  
  Aye
  
  3
  
  Nay
  
  3
  
  Aye with Reservations
  
  0
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  - - Health Committee Vote: May 21, 2024
      
      aye (9)
      
      Brouk
      
      Felder
      
      Hoylman-Sigal
      
      Mannion
      
      May
      
      Myrie
      
      Rivera
      
      Salazar
      
      Webb
      
      nay (3)
      
      Ashby
      
      Gallivan
      
      Martins
      
      aye wr (3)
      
      Rhoads
      
      Stec
      
      Thomas

Bill Amendments

Original

A (Active)

2023-S1727 - Details

Current Committee:: Senate Rules
Law Section:: Public Health Law
Laws Affected:: Amd §§2801-b & 4406-d, Pub Health L; amd §4803, Ins L
Versions Introduced in Other Legislative Sessions:: 2017-2018: S7357
2019-2020: S5280
2021-2022: S2116

2023-S1727 - Summary

Relates to improper practices relating to staff membership or professional privileges of a physician and such physician's board certification.

2023-S1727 - Sponsor Memo

                                 
BILL NUMBER: S1727

SPONSOR: RIVERA
 
TITLE OF BILL:

An act to amend the public health law and the insurance law, in relation
to improper practices relating to staff membership or professional priv-
ileges of a physician and board certification

 
PURPOSE:

Relates to improper practices relating to staff membership or profes-
sional privileges of a physician and such physician's board certif-
ication

 
SUMMARY OF SPECIFIC PROVISIONS:

Section 1 amends section 2801-b of the public health law as it relates
to improper practices of staff membership or professional privileges and
physician's board certification. This section prohibits the governing
body of a hospital to deny a physician staff membership or professional
privileges who was previously board-certified solely because such physi-

cian has not maintained such board certification.

Section 2 amends section 4406-d of the public health law as it relates
to minimum qualification requirements a healthcare professional must
meet in order to be considered for a healthcare plan. This section
prohibits an HMO from denying an application for participation in the
HMO's network to a physician who was previously board-certified solely
because such physicians have not maintained such board certification.

Section 3 of the bill amends section 4803 of the insurance law as it
relates to qualification requirements which a healthcare professional
must meet in order to be considered to participate in the in-network
portion of the insurance plan. This section prohibits a health insurer
from denying an application for participation in that health insurer's
network to a physician who was previously board-certified solely because
such physician has not maintained such board certification.

Section 4 provides an effective date.

 
JUSTIFICATION:

The cost of obtaining and updating board certification status is
increasingly becoming prohibitively expensive and time-consuming for
many physicians at a time when they are already being squeezed between
rapidly increasing office overhead costs and cuts in insurer payment.
Physicians are generally granted state medical licenses based upon
successfully passing medical school and internship examinations. Beyond
that, most physicians aspire to obtain specialty board certification as
it helps to denote to the public that the physician is appropriately
qualified to treat various medical conditions typically treated by that
specialty and advances in healthcare have required physicians to remain
current in their own specialty on a continuing basis. Physicians gener-
ally remain current in their knowledge base by attending seminars, read-
ing journals, discussions with other physicians, and various other
endeavors which are designed to continually improve a physician's deliv-
ery of medical care.

Many also seek to achieve and continually update their board certif-
ication status. These various specialty boards belong to a parent organ-
ization, the American Board of Medical Specialties (ABMS), which has
become increasingly active in lobbying for recertification examinations
to be mandatory on a periodic basis throughout a physician's career.
While initial board certification is an important step in a physician's
development, recertification on a periodic basis is not only unneces-
sary, there is no evidence that such recertification actually improves
the delivery of healthcare.  Moreover, the costs are becoming increas-
ingly prohibitively expensive. For older physicians, the cost may drive
them out of practicing medicine altogether. This legislation would help
to ensure that board certification remains aspirational for physicians,
but not mandatory, by ensuring that hospitals and health insurance
companies cannot impose such requirements as a condition of partic-
ipation, thereby reducing one barrier to delivering medical care in New
York State.

 
LEGISLATIVE HISTORY:

2019-2020: S5280/A5140 Schimminger

2021-2022: S2116

 
FISCAL IMPLICATIONS:

None to the state

 
EFFECTIVE DATE:
This act shall take effect immediately.

2023-S1727 - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1727
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                             January 13, 2023
                                ___________
 
 Introduced  by  Sen.  RIVERA -- read twice and ordered printed, and when
   printed to be committed 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.
                                                            LBD01818-01-3
 S. 1727                             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.

2023-S1727A (ACTIVE) - Details

Current Committee:: Senate Rules
Law Section:: Public Health Law
Laws Affected:: Amd §§2801-b & 4406-d, Pub Health L; amd §4803, Ins L
Versions Introduced in Other Legislative Sessions:: 2017-2018: S7357
2019-2020: S5280
2021-2022: S2116

2023-S1727A (ACTIVE) - Summary

Relates to improper practices relating to staff membership or professional privileges of a physician and such physician's board certification.

2023-S1727A (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S1727A

SPONSOR: RIVERA
 
TITLE OF BILL:

An act to amend the public health law and the insurance law, in relation
to improper practices relating to staff membership or professional priv-
ileges of a physician and board certification

 
PURPOSE OF BILL:

Relates to addressing the increasing burdens associated with maintaining
board certification for licensed healthcare professionals and ensuring
fair access to healthcare facilities and networks irrespective of
certification status.

 
SUMMARY OF PROVISIONS:

Section 1 amends section 2801-b of the public health law prohibits
improper practices by a hospital's governing body regarding applica-
tions, staff memberships, and professional privileges that result in the
exclusion or termination of a licensed professional for reasons unre-

lated to patient care, patient welfare, the institution's objectives, or
the applicant's character and competencies, but only for physicians who
have not maintained their board-certification.

Section 2 amends section 4406-d of the public health law as it relates
to minimum qualification standards for healthcare practitioners wanting
to participate in a healthcare plan network. This provision emphasizes
that a health care plan cannot deny approval for membership in its
network simply because a physician who was once board-certified but no
longer maintains current certification is not board-certified.

Section 3 of the bill amends section 4803 of the insurance law, address-
ing qualification requirements for healthcare professionals seeking
participation in an insurance plan's network. This stipulation assures
that insurers cannot prohibit network membership to physicians who
previously were board-certified but no longer maintain current certif-
ication or are lacking current board certification.

Section 4 provides an effective date.

 
JUSTIFICATION:

In today's healthcare landscape, the costs and time commitments associ-
ated with board certification are escalating the burden of obtaining and
maintaining them. Certification is becoming increasingly prohibitive,
particularly for physicians already grappling with rising overhead
expenses and reductions in insurer reimbursements.

Licensed professionals undergo rigorous training and examination proc-
esses to obtain their state medical licenses, demonstrating their compe-
tence to practice medicine. Physicians are generally issued state
medical licenses shortly after successfully passing medical school and
internship examinations. Beyond that, many physicians desire this
credential and pursue it because it is a recognized marker of expertise
and proficiency in a specific medical specialty, providing physicians
with enhanced credibility and opportunities for professional advance-
ment. However, the demands of maintaining ongoing board certification,
including costly recertification exams mandated by certain organiza-
tions, have placed undue strain on practitioners.

While initial board certification is an important milestone in a physi-
cian's development, frequent recertification on a periodic basis is not
only unnecessary, but there is no evidence that such recertification
actually improves the delivery of healthcare.  Physicians generally
remain current in their knowledge base by attending seminars, reading
journals, discussions with other physicians, and various other endeavors
that are designed to continually improve a physician's delivery of
medical care.  Furthermore, the expenditures are becoming more prohib-
itively high.  For older physicians, the cost may force them out of
practice completely. This legislation aims to alleviate these burdens
and ensure that licensed professionals are not unfairly barred from
providing essential healthcare services based solely on their certif-
ication status. By prohibiting hospitals and health insurance companies
from imposing arbitrary board certification requirements as conditions
for participation, we safeguard against discrimination and promote equi-
table access to healthcare facilities.

Instead of creating excessive bureaucratic hurdles, there should be an
emphasis on qualifications that are directly relevant to patient care.
By removing barriers to participation for licensed professionals who may
not maintain board certification, this legislation fosters a more inclu-
sive healthcare environment. It recognizes that physicians remain
current in their specialties through continuous education and profes-
sional development, independent of formal recertification processes, and
upholds the principles of fairness and equality within our healthcare
system, ensuring that patients receive care from a diverse array of
qualified practitioners.

 
LEGISLATIVE HISTORY:

2019-2020: S5280/A5140 Schimminger

2021-2022: S2116

 
FISCAL IMPLICATIONS:

None to the state

 
EFFECTIVE DATE:
This act shall take effect immediately.

2023-S1727A (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  1727--A
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                             January 13, 2023
                                ___________
 
 Introduced  by  Sen.  RIVERA -- read twice and ordered printed, and when
   printed to be committed to the Committee on Health --  recommitted  to
   the  Committee  on  Health in accordance with Senate Rule 6, sec. 8 --
   committee discharged, bill amended, ordered reprinted as  amended  and
   recommitted to said committee

 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
 PHYSICIAN, podiatrist, OPTOMETRIST, DENTIST, OR LICENSED  MIDWIFE  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-CERTI-
 FIED  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.
                                                            LBD01818-02-4
 S. 1727--A                          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] SUCH HEALTH CARE
 PROFESSIONAL  is credentialed; or (ii) whether additional time is neces-
 sary 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, 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 documentation. A  HEALTH  CARE  PLAN  MAY  NOT  REFUSE  TO
 APPROVE AN APPLICATION FROM A PHYSICIAN, WHO WAS PREVIOUSLY BOARD-CERTI-
 FIED  AND  WHO  HAS NOT MAINTAINED 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] SUCH
 HEALTH CARE PROFESSIONAL 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 addi-
 tional 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 APPLICATION FROM A PHYSICIAN, WHO WAS PREVIOUSLY BOARD-CERTI-
 FIED 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.

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