NY State Senate Bill 2025-S1911

Current Bill Status - In Senate Committee Health 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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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 14, 2025	referred to health

co-Sponsors

2025-S1911 (ACTIVE) - Details

Current Committee:: Senate Health
Law Section:: Public Health Law
Laws Affected:: Amd §4406-c, Pub Health L; amd §§3217-b & 4325, Ins L
Versions Introduced in Other Legislative Sessions:: 2013-2014: S5762
2015-2016: S4751
2017-2018: S3943
2019-2020: S3463
2021-2022: S2528
2023-2024: S3282

2025-S1911 (ACTIVE) - Summary

Clarifies provisions regarding health care professional applications and terminations.

2025-S1911 (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S1911

SPONSOR: RIVERA
 
TITLE OF BILL:

An act to amend the public health law and the insurance law, in relation
to health care professional applications and terminations

 
PURPOSE:

To establish a mediation process for physicians when a contract for
services is not renewed by a health plan.

 
SUMMARY OF SPECIFIC PROVISIONS:

Section 1 amends Subdivision 5-e of section 4406-c of the Public Health
Law, as it relates to prohibitions on health maintenance organizations,
and to authorizing a physician or physician group practice to initiate a
mediation to resolve outstanding contractual issues that are related to
a non-renewal by a health plan for the physician to provide in-network
services. The bill requires that mediation would have to occur 60 days
prior to the contract non-renewal. The mediator would be mutually agreed

upon and the results of the mediation would be non-binding. One week
prior to the mediation, the parties must disclose to each other a writ-
ten statement on their position including any rationale for the decision
to renew.

Section 2 amends Subsection (I) of section 3217-b of the Insurance Law,
to make conforming changes mirroring those in section 1 of the bill for
insurance plan contracts with a physician or physician group practice.

Section 3 amends subsection (m) of section 4325 of the Insurance Law, to
also mirror the amendments made in section 1 of the bill, as it relates
to Prohibitions of Non-Profit Medical and Dental Indemnity insurance
plan contracts with a physician or physician group practice.  These
provisions would apply to both publicly subsidized and private health
products that are regulated by New York State.

Section 4 provides the effective date

 
JUSTIFICATION:

The patient-physician relationship is crucial for delivering high-quali-
ty healthcare effectively and efficiently. A physician's understanding
of a patient's medical history, and overall patient engagement in manag-
ing their health, combined with the clinical expertise of the physician,
significantly enhances the likelihood of the patient receiving the most
optimal and efficient care.

As part of New York's Managed Care Bill of Rights, the Legislature
recognized the value gained by preserving the patient's relationships
with their provider by establishing meaningful due process protections
for all providers by prohibiting plans from terminating a provider with-
out notice and without an opportunity to be heard by a panel of clinical
peers. However, there have been instances where insurers have avoided
triggering these important protections by waiting to drop physicians
from their networks until the expiration of their participating contract
for reasons that may be related to these physicians challenging the
insurer's payment practices or the physician's referral of patients to
certain necessary specialists. This bill would establish protections for
contract non-renewals to assure that such non-renewals occur for valid
reasons.

 
LEGISLATIVE HISTORY:

2013-2014: S.5762 Hannon/A.6498 Lavine

2015-16: S.4751 Hannon/A.1212 Lavine

2017-2018: S.3943 Hannon/A.2704 Lavine

2019-2020: S.3463/A.2835 Lavine

2021-2022: S.2528/A.4177 Lavine

2023-2024: S3282-A Rivera/A.1777-A Lavine

 
FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
Takes effect on the 90th day following enactment.

2025-S1911 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1911
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                             January 14, 2025
                                ___________
 
 Introduced  by  Sens.  RIVERA, CLEARE -- 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 health care professional applications and terminations
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subdivision 5-e of section 4406-c of the public health law,
 as  added  by  chapter  377  of  the laws of 2019, is amended to read as
 follows:
   5-e. (A) At least sixty days prior to the termination  of  a  contract
 between  a  hospital and a health care plan, the parties shall utilize a
 mutually agreed upon mediator to assist  in  resolving  any  outstanding
 contractual issues. The results of the mediation shall not be binding on
 the parties.
   (B)  AT  LEAST  SIXTY DAYS PRIOR TO THE EXPIRATION OR NON-RENEWAL OF A
 CONTRACT BETWEEN A PHYSICIAN OR PHYSICIAN GROUP PRACTICE  AND  A  HEALTH
 CARE  PLAN,  A  PHYSICIAN  OR  PHYSICIAN GROUP MAY, AT THEIR DISCRETION,
 UTILIZE A MUTUALLY AGREED UPON  MEDIATOR  TO  ASSIST  IN  RESOLVING  ANY
 OUTSTANDING  CONTRACTUAL  ISSUES.  AT  LEAST ONE WEEK PRIOR TO THE MEDI-
 ATION, THE PARTIES SHALL PROVIDE A WRITTEN  STATEMENT  EXPLAINING  THEIR
 RESPECTIVE  POSITIONS,  INCLUDING BUT NOT LIMITED TO THEIR RATIONALE FOR
 THE DECISION, REGARDING  THE NON-RENEWAL OF THE CONTRACT.   THE  RESULTS
 OF  THE  MEDIATION  SHALL  NOT  BE  BINDING ON THE PARTIES. A TERMINATED
 CONTRACT BETWEEN SUCH PARTIES SHALL BE GOVERNED BY SECTION FOUR THOUSAND
 FOUR HUNDRED SIX-D OF THIS ARTICLE.
   § 2. Subsection (l) of section 3217-b of the insurance law,  as  added
 by chapter 377 of the laws of 2019, is amended to read as follows:
   (l)  (1)  At  least  sixty days prior to the termination of a contract
 between a hospital and an insurer, the parties shall utilize a  mutually
 agreed  upon mediator to assist in resolving any outstanding contractual
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD03549-01-5
 S. 1911                             2

 
 issues.   The results of the mediation  shall  not  be  binding  on  the
 parties.
   (2)  AT  LEAST  SIXTY DAYS PRIOR TO THE EXPIRATION OR NON-RENEWAL OF A
 CONTRACT BETWEEN A  PHYSICIAN OR PHYSICIAN GROUP PRACTICE AND AN  INSUR-
 ER,  A  PHYSICIAN OR PHYSICIAN GROUP MAY, AT THEIR DISCRETION, UTILIZE A
 MUTUALLY AGREED UPON MEDIATOR TO ASSIST  IN  RESOLVING  ANY  OUTSTANDING
 CONTRACTUAL  ISSUES.  AT  LEAST  ONE  WEEK  PRIOR  TO THE MEDIATION, THE
 PARTIES SHALL PROVIDE A WRITTEN STATEMENT  EXPLAINING  THEIR  RESPECTIVE
 POSITIONS,  INCLUDING  BUT  NOT LIMITED TO THEIR RATIONALE FOR THE DECI-
 SION, REGARDING THE   NON-RENEWAL OF THE CONTRACT. THE  RESULTS  OF  THE
 MEDIATION  SHALL  NOT  BE  BINDING ON THE PARTIES. A TERMINATED CONTRACT
 BETWEEN SUCH PARTIES SHALL BE GOVERNED BY SECTION  FOUR  THOUSAND  EIGHT
 HUNDRED THREE OF THIS CHAPTER.
   §  3. Subsection (m) of section 4325 of the insurance law, as added by
 chapter 377 of the laws of 2019, is amended to read as follows:
   (m) (1) At least sixty days prior to the  termination  of  a  contract
 between  a  hospital  and  an  organization, the parties shall utilize a
 mutually agreed upon mediator to assist  in  resolving  any  outstanding
 contractual issues. The results of the mediation shall not be binding on
 the parties.
   (2)  AT  LEAST  SIXTY DAYS PRIOR TO THE EXPIRATION OR NON-RENEWAL OF A
 CONTRACT BETWEEN A  PHYSICIAN OR PHYSICIAN GROUP PRACTICE AND  A  CORPO-
 RATION, A PHYSICIAN OR PHYSICIAN GROUP MAY, AT THEIR DISCRETION, UTILIZE
 A  MUTUALLY  AGREED UPON MEDIATOR TO ASSIST IN RESOLVING ANY OUTSTANDING
 CONTRACTUAL ISSUES. AT LEAST  ONE  WEEK  PRIOR  TO  THE  MEDIATION,  THE
 PARTIES  SHALL  PROVIDE  A WRITTEN STATEMENT EXPLAINING THEIR RESPECTIVE
 POSITIONS, INCLUDING BUT NOT LIMITED TO THEIR RATIONALE  FOR  THE  DECI-
 SION,  REGARDING  THE  NON-RENEWAL OF THE CONTRACT.   THE RESULTS OF THE
 MEDIATION SHALL NOT BE BINDING ON THE  PARTIES.  A  TERMINATED  CONTRACT
 BETWEEN  SUCH  PARTIES  SHALL BE GOVERNED BY SECTION FOUR THOUSAND EIGHT
 HUNDRED THREE OF THIS CHAPTER.
   § 4. This act shall take effect on the ninetieth day  after  it  shall
 have become a law.

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Senate Bill S1911

Sponsored By

Current Bill Status - In Senate Committee Health Committee

co-Sponsors

2025-S1911 (ACTIVE) - Details

2025-S1911 (ACTIVE) - Summary

2025-S1911 (ACTIVE) - Sponsor Memo

2025-S1911 (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S1911

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Sponsored By

Gustavo Rivera

Current Bill Status - In Senate Committee Health Committee

co-Sponsors

Cordell Cleare

2025-S1911 (ACTIVE) - Details

2025-S1911 (ACTIVE) - Summary

2025-S1911 (ACTIVE) - Sponsor Memo

2025-S1911 (ACTIVE) - Bill Text download pdf

Comments