NY State Senate Bill 2025-S1911A

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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Actions

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Apr 16, 2025	print number 1911a
Apr 16, 2025	amend and recommit to health
Jan 14, 2025	referred to health

Bill Amendments

Original

A (Active)

co-Sponsors

2025-S1911 - Details

Current Committee:: Senate Health
Law Section:: Public Health Law
Laws Affected:: Amd §4406-d, Pub Health L; amd §4803, 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 - Summary

Clarifies provisions regarding health care professional applications and terminations.

2025-S1911 - 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 - 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.

co-Sponsors

2025-S1911A (ACTIVE) - Details

Current Committee:: Senate Health
Law Section:: Public Health Law
Laws Affected:: Amd §4406-d, Pub Health L; amd §4803, 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-S1911A (ACTIVE) - Summary

Clarifies provisions regarding health care professional applications and terminations.

2025-S1911A (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S1911A

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 provide health care practitioners with due process protections in
order to allow and encourage a meaningful continuity of care to health
insurance enrollees.

 
SUMMARY OF PROVISIONS:

Section 1 amends section 4406-d of the Public Health Law to clarify the
due process protections afforded to a health care professional for
contract terminations also apply in instances of non-renewal.  This
section also refines the process by which members of a hearing panel are
chosen to require that the panel be comprised of at least three NYS
licensed healthcare professionals, that one member is appointed by the

insurer, one is appointed by the subject of the hearing and that the
third panelist is chosen by the other two panel members.

Section 2 amends section 4803 of the Insurance Law to clarify the due
process protections afforded to a health care professional for contract
terminations. This section also refines the process by which members of
a hearing panel are chosen to require that the panel be comprised of at
least three NYS licensed healthcare professionals, that one member is
appointed by the insurer, one is appointed by the subject of the hearing
and that the third panelist is chosen by the other two panel members.

Section 3 provides the effective date.

 
JUSTIFICATION:

The relationship between a patient and his or her physician is integral
to the effective and efficient provision of quality health care
services. The better a physician knows a patient, knows the patient's
history, is aware of the patient's level of participation in improving
his or her own health and can meld these factors with the scientific
practice of medicine, the more likely the patient will receive the best
and most efficient health 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, in some instances 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 needed
specialists. This bill would extend these important statutory due proc-
ess protections, currently applicable to contract terminations, to
contract non-renewals to assure that such non-renewals occur for valid
reasons.
 
LEGISLATIVE HISTORY:

2013-2014: S5762 Hannon/A6498 Lavine

2015-2016: S4751 Hannon/A1212 Lavine

2017-2018: S3943 Hannon/A2704 Lavine

2019-2020: S3463 Rivera/A2835 Lavine

2021-2022: S2528 Rivera/A4177 Lavine

2023-2024: S3282-A Rivera/A1777-A Lavine

 
FISCAL IMPLICATIONS:S:

None.

 
EFFECTIVE DATE:
Effective Immediately.

2025-S1911A (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  1911--A
 
                        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 -- commit-
   tee discharged, bill amended, ordered reprinted as amended and  recom-
   mitted to said committee
 
 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. Subdivisions 2, 3, 4, 5, 6, 7, 8 and 9 of section 4406-d of
 the public health law, as added by chapter 705 of the laws of 1996,  are
 amended to read as follows:
   2.  (a) A health care plan shall not terminate OR NOT RENEW a contract
 with a health care professional unless the health care plan provides  to
 the  health  care  professional a written explanation of the reasons for
 the proposed contract termination and an opportunity  for  a  review  or
 hearing  as  hereinafter provided. This section shall not apply in cases
 involving imminent harm to patient care, a determination of fraud, or  a
 final  disciplinary  action  by a state licensing board or other govern-
 mental agency that impairs the health  care  professional's  ability  to
 practice.
   (b)  The  notice  of  the proposed contract termination OR NON-RENEWAL
 provided by the health care plan to the health care  professional  shall
 include:
   (i) the reasons for the proposed action;
   (ii) notice that the health care professional has the right to request
 a  hearing  or  review, at the professional's discretion, before a panel
 [appointed by the health care plan] COMPRISED OF  NO  FEWER  THAN  THREE
 HEALTH CARE PROFESSIONALS LICENSED TO PRACTICE IN THE STATE OF NEW YORK;
   (iii)  a time limit of not less than thirty days within which a health
 care professional may request a hearing; and
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD03549-02-5
 S. 1911--A                          2

 
   (iv) a time limit for a hearing date which must be held within  thirty
 days after the date of receipt of a request for a hearing.
   (c)  The  hearing panel shall be comprised of three [persons appointed
 by the health care plan] HEALTH CARE PROFESSIONALS LICENSED TO  PRACTICE
 BY  THE  STATE  OF NEW YORK IN THE SAME PROFESSION AS THE SUBJECT OF THE
 REVIEW, ONE OF WHOM IS APPOINTED BY THE HEALTH CARE PLAN, ONE OF WHOM IS
 APPOINTED BY THE HEALTH CARE PROFESSIONAL WHO  IS  THE  SUBJECT  OF  THE
 HEARING.  THE REMAINING MEMBER OF THE PANEL SHALL BE CHOSEN BY THE OTHER
 TWO PANEL MEMBERS. At least one person on such panel shall be a clinical
 peer in the same discipline and the same or  similar  specialty  as  the
 health  care professional under review. The hearing panel may consist of
 more than three persons, provided however that the  number  of  clinical
 peers  on  such  panel  shall  constitute one-third or more of the total
 membership of the panel AND PROVIDED  FURTHER  THAT  THE  RATIO  OF  THE
 NUMBER OF HEALTH CARE PROFESSIONALS APPOINTED BY THE HEALTH CARE PLAN TO
 THE  NUMBER OF HEALTH CARE PROFESSIONALS APPOINTED BY THE SUBJECT OF THE
 HEARING TO THE NUMBER OF HEALTH CARE PROFESSIONALS CHOSEN BY  THE  OTHER
 PANEL MEMBERS REMAINS ONE TO ONE TO ONE.
   (d)  The  hearing panel shall render a decision on the proposed action
 in a timely manner. Such decision shall  include  reinstatement  of  the
 health  care  professional  by  the  health care plan, provisional rein-
 statement subject to conditions set forth by the  health  care  plan  or
 termination  of  the  health  care  professional. Such decision shall be
 provided in writing to the health care professional.
   (e) A decision by the hearing panel to terminate OR NOT RENEW a health
 care professional shall be effective not less than thirty days after the
 receipt by the health care professional of the hearing panel's decision;
 provided, however, that the provisions of paragraph (e)  of  subdivision
 six  of  section  [four  thousand four] FORTY-FOUR hundred three of this
 article shall apply to such termination OR NON-RENEWAL.
   (f) In no event shall termination be effective earlier than sixty days
 from the receipt of the notice of termination.
   3. [Either party to a contract may exercise a right of non-renewal  at
 the  expiration  of  the  contract  period  set  forth therein or, for a
 contract without a specific  expiration  date,  on  each  January  first
 occurring  after  the contract has been in effect for at least one year,
 upon sixty days notice to the other party; provided, however,  that  any
 non-renewal  shall  not  constitute  a  termination for purposes of this
 section.
   4.] A health care plan shall develop and implement policies and proce-
 dures to ensure that health care professionals are regularly informed of
 information maintained by the health care plan to evaluate the  perform-
 ance  or  practice of the health care professional. The health care plan
 shall consult with health care professionals in developing methodologies
 to collect and analyze health care professional profiling  data.  Health
 care  plans  shall  provide  any such information and profiling data and
 analysis to health care professionals. Such information, data or  analy-
 sis  shall be provided on a periodic basis appropriate to the nature and
 amount of data and the volume and  scope  of  services  provided.    Any
 profiling  data used to evaluate the performance or practice of a health
 care professional shall be  measured  against  stated  criteria  and  an
 appropriate  group  of health care professionals using similar treatment
 modalities serving a comparable patient population. Upon presentation of
 such information or data, each health care professional shall  be  given
 the  opportunity to discuss the unique nature of the health care profes-
 sional's patient population which may have a bearing on the health  care
 S. 1911--A                          3
 
 professional's  profile  and  to work cooperatively with the health care
 plan to improve performance.
   [5.]  4. No health care plan shall terminate a contract or employment,
 or refuse to renew a contract, solely because  a  health  care  provider
 has:
   (a) advocated on behalf of an enrollee;
   (b) filed a complaint against the health care plan;
   (c) appealed a decision of the health care plan;
   (d)  provided information or filed a report pursuant to section forty-
 four hundred six-c of this article; or
   (e) requested a hearing or review pursuant to this section.
   [6.] 5. Except as provided herein, no contract or agreement between  a
 health  care  plan  and  a  health  care  professional shall contain any
 provision which shall supersede or impair a health  care  professional's
 right to notice of reasons for termination OR NON-RENEWAL and the oppor-
 tunity  for a hearing or review concerning such termination OR NON-RENE-
 WAL.
   [7.] 6. Any contract provision in violation of this section  shall  be
 deemed to be void and unenforceable.
   [8.]  7. For purposes of this section, "health care plan" shall mean a
 health maintenance organization licensed pursuant to article forty-three
 of the insurance law or certified pursuant to this article or  an  inde-
 pendent  practice  association  certified or recognized pursuant to this
 article.
   [9.] 8. For purposes of this section, "health care professional" shall
 mean a health care professional licensed, registered or certified pursu-
 ant to title eight of the education law.
   § 2. Subsections (b), (c), (d), (e), (f), (g) and (h) of section  4803
 of  the  insurance law, as added by chapter 705 of the laws of 1996, are
 amended to read as follows:
   (b) (1) An insurer shall not terminate OR NOT RENEW a contract with  a
 health  care  professional  for participation in the in-network benefits
 portion of the insurer's network for a managed care product  unless  the
 insurer  provides  to the health care professional a written explanation
 of the reasons for the proposed contract termination and an  opportunity
 for  a review or hearing as hereinafter provided. This section shall not
 apply in cases involving imminent harm to patient care, a  determination
 of  fraud,  or a final disciplinary action by a state licensing board or
 other governmental agency that impairs the  health  care  professional's
 ability to practice.
   (2)  The  notice  of  the proposed contract termination OR NON-RENEWAL
 provided by the insurer to the health care professional shall include:
   (i) the reasons for the proposed action;
   (ii) notice that the health care professional has the right to request
 a hearing or review, at the professional's discretion,  before  a  panel
 [appointed  by the insurer] COMPRISED OF NO FEWER THAN THREE HEALTH CARE
 PROFESSIONALS LICENSED TO PRACTICE BY THE STATE OF NEW YORK;
   (iii) a time limit of not less than thirty days within which a  health
 care professional may request a hearing or review; and
   (iv)  a  time  limit  for a hearing date which must be held within not
 less than thirty days after the date of receipt of a request for a hear-
 ing.
   (3) The hearing panel shall be comprised of three  [persons  appointed
 by  the  insurer]  HEALTH CARE PROFESSIONALS LICENSED TO PRACTICE BY THE
 STATE OF NEW YORK IN THE SAME PROFESSION AS THE SUBJECT OF  THE  REVIEW,
 ONE OF WHOM IS APPOINTED BY THE INSURER, ONE OF WHOM IS APPOINTED BY THE
 S. 1911--A                          4
 
 HEALTH  CARE PROFESSIONAL WHO IS THE SUBJECT OF THE HEARING. THE REMAIN-
 ING MEMBER OF THE PANEL SHALL BE CHOSEN BY THE OTHER TWO PANEL  MEMBERS.
 At  least  one person on such panel shall be a clinical peer in the same
 discipline  and the same or similar specialty as the health care profes-
 sional under review. The hearing panel may consist of  more  than  three
 persons,  provided  however  that  the  number of clinical peers on such
 panel shall constitute one-third or more of the total membership of  the
 panel  AND  PROVIDED FURTHER THAT THE RATIO OF THE NUMBER OF HEALTH CARE
 PROFESSIONALS APPOINTED BY THE HEALTH CARE PLAN TO THE NUMBER OF  HEALTH
 CARE PROFESSIONALS APPOINTED BY THE SUBJECT OF THE HEARING TO THE NUMBER
 OF  HEALTH  CARE  PROFESSIONALS  CHOSEN  BY  THE TWO OTHER PANEL MEMBERS
 REMAINS ONE TO ONE TO ONE.
   (4) The hearing panel shall render a decision on the  proposed  action
 in  a  timely  manner.  Such decision shall include reinstatement of the
 health care  professional  by  the  insurer,  provisional  reinstatement
 subject  to  conditions  set  forth by the insurer or termination of the
 health care professional. Such decision shall be provided in writing  to
 the health care professional.
   (5) A decision by the hearing panel to terminate OR NOT RENEW a health
 care professional shall be effective not less than thirty days after the
 receipt by the health care professional of the hearing panel's decision;
 provided, however, that the provisions of subsection (e) of section four
 thousand  eight  hundred four OF THIS ARTICLE shall apply to such termi-
 nation.
   (6) In no event shall termination OR NON-RENEWAL be effective  earlier
 than sixty days from the receipt of the notice of termination OR NON-RE-
 NEWAL.
   (c)  [Either  party  to a contract for participation in the in-network
 benefits portion of an insurer's network for a managed care product  may
 exercise a right of non-renewal at the expiration of the contract period
 set forth therein or, for a contract without a specific expiration date,
 on  each  January  first occurring after the contract has been in effect
 for at least one year, upon  sixty  days  notice  to  the  other  party;
 provided,  however,  that  any non-renewal shall not constitute a termi-
 nation for purposes of this section.
   (d)] An insurer shall develop and implement policies and procedures to
 ensure that health care providers participating in [the] the  in-network
 benefits  portion of an insurer's network for a managed care product are
 regularly informed of information maintained by the insurer to  evaluate
 the performance or practice of the health care professional. The insurer
 shall consult with health care professionals in developing methodologies
 to  collect  and analyze provider profiling data. Insurers shall provide
 any such information and profiling data and  analysis  to  these  health
 care professionals. Such information, data or analysis shall be provided
 on a periodic basis appropriate to the nature and amount of data and the
 volume and scope of services provided. Any profiling data used to evalu-
 ate the performance or practice of such a health care professional shall
 be  measured  against stated criteria and an appropriate group of health
 care professionals using similar treatment modalities serving a compara-
 ble patient population. Upon presentation of such information  or  data,
 each  such  health  care  professional shall be given the opportunity to
 discuss the unique nature of  the  health  care  professional's  patient
 population which may have a bearing on the professional's profile and to
 work cooperatively with the insurer to improve performance.
   [(e)] (D) No insurer shall terminate or refuse to renew a contract for
 participation in the in-network benefits portion of an insurer's network
 S. 1911--A                          5
 
 for  a  managed care product solely because the health care professional
 has (1) advocated on behalf of an insured; (2)  has  filed  a  complaint
 against  the  insurer;  (3)  has appealed a decision of the insurer; (4)
 provided  information  or  filed a report pursuant to section forty-four
 hundred six-c of the public health law; or (5) requested  a  hearing  or
 review pursuant to this section.
   [(f)]  (E) Except as provided herein, no contract or agreement between
 an insurer and a health  care  professional  for  participation  in  the
 in-network  benefits  portion of an insurer's network for a managed care
 product shall contain any provision which shall supersede  or  impair  a
 health care professional's right to notice of reasons for termination OR
 NON-RENEWAL  and  the  opportunity  for a hearing concerning such termi-
 nation OR NON-RENEWAL.
   [(g)] (F) Any contract provision in violation of this section shall be
 deemed to be void and unenforceable.
   [(h)] (G) For purposes of this  section,  "health  care  professional"
 shall  mean a health care professional licensed, registered or certified
 pursuant to title eight of the education law.
   § 3. This act shall take effect immediately.

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Senate Bill S1911A

Sponsored By

Current Bill Status - In Senate Committee Health Committee

Bill Amendments

co-Sponsors

2025-S1911 - Details

2025-S1911 - Summary

2025-S1911 - Sponsor Memo

2025-S1911 - Bill Text download pdf

co-Sponsors

2025-S1911A (ACTIVE) - Details

2025-S1911A (ACTIVE) - Summary

2025-S1911A (ACTIVE) - Sponsor Memo

2025-S1911A (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S1911A

Share this bill

Sponsored By

Gustavo Rivera

Current Bill Status - In Senate Committee Health Committee

Bill Amendments

co-Sponsors

Cordell Cleare

2025-S1911 - Details

2025-S1911 - Summary

2025-S1911 - Sponsor Memo

2025-S1911 - Bill Text download pdf

co-Sponsors

Cordell Cleare

2025-S1911A (ACTIVE) - Details

2025-S1911A (ACTIVE) - Summary

2025-S1911A (ACTIVE) - Sponsor Memo

2025-S1911A (ACTIVE) - Bill Text download pdf

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