S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  4785--A
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                             February 14, 2023
                                ___________
 
 Introduced  by  Sens. RIVERA, COMRIE, HARCKHAM, KRUEGER, MAY, SKOUFIS --
   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 commit-
   tee
 
 AN ACT to amend the public health law, in relation to  requirements  for
   collective  negotiations  by health care providers with certain health
   benefit plans
 
   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 system of collective  action  on  behalf  of  health  care
 providers. Consequently, the legislature finds it appropriate and neces-
 sary  to  displace  competition  with regulation of health plan-provider
 agreements and authorize collective negotiations on the terms and condi-
 tions 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 which arise
 under applicable federal or state collective bargaining statutes.
   § 2. This act shall be known and may be  cited  as  the  "health  care
 consumer and provider protection act".
   §  3.  Article  49 of the public health law is amended by adding a new
 title III to read as follows:
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD08052-02-4
              

 S. 4785--A                          2
 
                                 TITLE III
                  COLLECTIVE NEGOTIATIONS BY HEALTH CARE
                     PROVIDERS WITH HEALTH CARE PLANS
 SECTION 4920. DEFINITIONS.
         4920-A. NON-FEE RELATED COLLECTIVE NEGOTIATION AUTHORIZED.
         4920-B. FEE RELATED COLLECTIVE NEGOTIATION.
         4920-C. COLLECTIVE NEGOTIATION REQUIREMENTS.
         4920-D. REQUIREMENTS FOR HEALTH CARE PROVIDERS' REPRESENTATIVE.
         4920-E. CERTAIN COLLECTIVE ACTION PROHIBITED.
         4920-F. FEES.
         4920-G. MONITORING OF AGREEMENTS.
         4920-H. CONFIDENTIALITY.
         4920-I. 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, 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 HEALTH CARE PROVIDER OR HEALTH CARE PROVIDERS TO GAIN COMPLI-
 ANCE WITH DEMANDS MADE ON A HEALTH CARE PLAN.
   5. "SUBSTANTIAL MARKET SHARE IN A BUSINESS LINE" EXISTS  IF  A  HEALTH
 CARE  PLAN'S  MARKET SHARE OF A BUSINESS LINE WITHIN THE GEOGRAPHIC AREA
 FOR WHICH A NEGOTIATION HAS BEEN APPROVED BY THE COMMISSIONER, 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
 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  SIGNIFICANTLY  EXCEEDS  THE  COUNTERVAILING
 MARKET SHARE OF THE PROVIDERS ACTING INDIVIDUALLY.
   6.  "HEALTH  CARE PROVIDER" MEANS A PERSON WHO IS LICENSED, CERTIFIED,
 REGISTERED OR AUTHORIZED PURSUANT TO TITLE EIGHT OF  THE  EDUCATION  LAW
 AND  WHO PRACTICES THAT PROFESSION AS A HEALTH CARE PROVIDER AS AN INDE-
 PENDENT CONTRACTOR AND/OR WHO IS  AN  OWNER,  OFFICER,  SHAREHOLDER,  OR
 PROPRIETOR  OF  A  HEALTH  CARE  PROVIDER,  OR AN ENTITY THAT EMPLOYS OR
 UTILIZES HEALTH CARE PROVIDERS TO PROVIDE HEALTH CARE SERVICES,  INCLUD-
 ING BUT NOT LIMITED TO A HOSPITAL LICENSED UNDER ARTICLE TWENTY-EIGHT OF
 THIS  CHAPTER  OR AN ACCOUNTABLE CARE ORGANIZATION UNDER ARTICLE TWENTY-
 NINE-E OF THIS CHAPTER; OR AN ENTITY AUTHORIZED UNDER  ARTICLES  THIRTY-
 SIX  OR FORTY OF THIS CHAPTER; OR A FISCAL INTERMEDIARY OPERATING PURSU-
 ANT TO SECTION THREE HUNDRED SIXTY-FIVE-F OF THE SOCIAL SERVICES LAW.  A
 HEALTH CARE PROVIDER UNDER TITLE EIGHT OF THE EDUCATION  LAW  WHO  PRAC-
 TICES  AS  AN  EMPLOYEE  OF A HEALTH CARE PROVIDER SHALL NOT BE DEEMED A
 HEALTH CARE PROVIDER FOR PURPOSES OF THIS TITLE.
 S. 4785--A                          3
 
   § 4920-A. NON-FEE RELATED COLLECTIVE NEGOTIATION AUTHORIZED. 1. HEALTH
 CARE PROVIDERS PRACTICING WITHIN THE GEOGRAPHIC AREA FOR WHICH A NEGOTI-
 ATION HAS BEEN APPROVED BY THE COMMISSIONER MAY MEET AND COMMUNICATE FOR
 THE PURPOSE OF COLLECTIVELY NEGOTIATING THE FOLLOWING TERMS  AND  CONDI-
 TIONS 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-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.
   § 4920-B. FEE RELATED COLLECTIVE NEGOTIATION. 1. IF  THE  HEALTH  CARE
 PLAN  HAS  SUBSTANTIAL MARKET SHARE IN A BUSINESS LINE IN ANY GEOGRAPHIC
 AREA FOR WHICH A NEGOTIATION HAS  BEEN  APPROVED  BY  THE  COMMISSIONER,
 HEALTH CARE PROVIDERS PRACTICING WITHIN THAT GEOGRAPHIC AREA MAY COLLEC-
 S. 4785--A                          4
 
 TIVELY  NEGOTIATE  THE  FOLLOWING  TERMS AND CONDITIONS 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.
   § 4920-C. COLLECTIVE NEGOTIATION REQUIREMENTS. 1.  COLLECTIVE  NEGOTI-
 ATION  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 GEOGRAPHIC AREA
 FOR WHICH A NEGOTIATION HAS BEEN APPROVED BY  THE  COMMISSIONER  IF  THE
 HEALTH  CARE  PLAN COVERS LESS THAN FIVE PERCENT OF THE ACTUAL NUMBER OF
 COVERED LIVES OF THE HEALTH CARE PLAN IN THE 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.
   § 4920-D. 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-
 TATIVE'S PLAN OF  OPERATION,  AND  THE  REPRESENTATIVE'S  PROCEDURES  TO
 ENSURE COMPLIANCE WITH THIS TITLE.
 S. 4785--A                          5
 
   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 AND THE
 ATTORNEY GENERAL, THE  COMMISSIONER  SHALL  APPROVE  OR  DISAPPROVE  THE
 REPORT  NOT  LATER  THAN  THE  TWENTIETH DAY AFTER THE DATE ON WHICH THE
 REPORT IS FILED. IF DISAPPROVED, THE COMMISSIONER SHALL FURNISH A  WRIT-
 TEN  EXPLANATION OF ANY DEFICIENCIES, ALONG WITH A STATEMENT OF SPECIFIC
 PROPOSALS FOR REMEDIAL MEASURES TO CURE THE DEFICIENCIES. IF THE COMMIS-
 SIONER 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;
 S. 4785--A                          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.
   10.  THE  COMMISSIONER  MAY  COLLECT INFORMATION FROM OTHER PERSONS TO
 ASSIST IN EVALUATING THE IMPACT  OF  THE  PROPOSED  ARRANGEMENT  ON  THE
 HEALTH CARE MARKETPLACE. THE COMMISSIONER SHALL COLLECT INFORMATION FROM
 HEALTH  PLAN  COMPANIES  AND HEALTH CARE PROVIDERS OPERATING IN THE SAME
 GEOGRAPHIC AREA.
   § 4920-E. 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.
   §  4920-F. FEES. EACH PERSON WHO ACTS AS THE REPRESENTATIVE OR NEGOTI-
 ATING 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 - 003 FOR THE NEW YORK STATE DEPARTMENT OF
 HEALTH FUND.
   § 4920-G. 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.
   §  4920-H. CONFIDENTIALITY. ALL REPORTS AND OTHER INFORMATION REQUIRED
 TO BE REPORTED TO THE DEPARTMENT  OF  LAW  UNDER  THIS  TITLE  INCLUDING
 INFORMATION  OBTAINED BY THE COMMISSIONER PURSUANT TO SUBDIVISION TEN OF
 SECTION FORTY-NINE HUNDRED TWENTY-D OF THIS TITLE SHALL NOT  BE  SUBJECT
 TO  DISCLOSURE  UNDER  ARTICLE SIX OF THE PUBLIC OFFICERS LAW OR ARTICLE
 THIRTY-ONE OF THE CIVIL PRACTICE LAW AND RULES.
   § 4920-I. 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-
 S. 4785--A                          7
 
 CABILITY SHALL NOT BE AFFECTED. THE PROVISIONS OF THIS  TITLE  SHALL  BE
 LIBERALLY CONSTRUED TO GIVE EFFECT TO THE PURPOSES THEREOF.
   § 4. This act shall take effect on the one hundred twentieth day after
 it  shall have become a law; provided that the commissioner of health is
 authorized to promulgate any and all rules and regulations and take  any
 other  measures necessary to implement this act on its effective date on
 or before such date.