Bill Text: NY S05280 | 2019-2020 | General Assembly | Introduced
Bill Title: Relates to improper practices relating to staff membership or professional privileges of a physician and such physician's board certification.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2020-01-08 - REFERRED TO HEALTH [S05280 Detail]
Download: New_York-2019-S05280-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 5280 2019-2020 Regular Sessions IN SENATE April 23, 2019 ___________ 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: 1 Section 1. Subdivision 1 of section 2801-b of the public health law, 2 as amended by chapter 605 of the laws of 2008, is amended to read as 3 follows: 4 1. It shall be an improper practice for the governing body of a hospi- 5 tal to refuse to act upon an application for staff membership or profes- 6 sional privileges or to deny or withhold from a physician, podiatrist, 7 optometrist, dentist or licensed midwife staff membership or profes- 8 sional privileges in a hospital, or to exclude or expel a physician, 9 podiatrist, optometrist, dentist or licensed midwife from staff member- 10 ship in a hospital or curtail, terminate or diminish in any way a physi- 11 cian's, podiatrist's, optometrist's, dentist's or licensed midwife's 12 professional privileges in a hospital, without stating the reasons 13 therefor, or if the reasons stated are unrelated to standards of patient 14 care, patient welfare, the objectives of the institution or the charac- 15 ter or competency of the applicant. It shall be an improper practice for 16 a governing body of a hospital to refuse to act upon an application or 17 to deny or to withhold staff membership or professional privileges to a 18 podiatrist based solely upon a practitioner's category of licensure. It 19 shall be an improper practice for a governing body of a hospital to 20 refuse to act upon an application or to deny or to withhold staff 21 membership or professional privileges of a physician who was previously 22 board-certified and who has not maintained such certification solely 23 because such physician is not board-certified. EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD09133-01-9S. 5280 2 1 § 2. Paragraph (a) of subdivision 1 of section 4406-d of the public 2 health law, as amended by chapter 425 of the laws of 2016, is amended to 3 read as follows: 4 (a) A health care plan shall, upon request, make available and 5 disclose to health care professionals written application procedures and 6 minimum qualification requirements which a health care professional must 7 meet in order to be considered by the health care plan. The plan shall 8 consult with appropriately qualified health care professionals in devel- 9 oping its qualification requirements. A health care plan shall complete 10 review of the health care professional's application to participate in 11 the in-network portion of the health care plan's network and shall, 12 within sixty days of receiving a health care professional's completed 13 application to participate in the health care plan's network, notify the 14 health care professional as to: (i) whether he or she is credentialed; 15 or (ii) whether additional time is necessary to make a determination 16 because of a failure of a third party to provide necessary documenta- 17 tion. In such instances where additional time is necessary because of a 18 lack of necessary documentation, a health plan shall make every effort 19 to obtain such information as soon as possible and shall make a final 20 determination within twenty-one days of receiving the necessary documen- 21 tation. A health care plan may not refuse to approve an application from 22 a physician, who was previously board-certified and who has not main- 23 tained such certification, to participate in the in-network portion of 24 the health care plan's network solely because such physician is not 25 board-certified. 26 § 3. Paragraph 1 of subsection (a) of section 4803 of the insurance 27 law, as amended by chapter 425 of the laws of 2016, is amended to read 28 as follows: 29 (1) An insurer which offers a managed care product shall, upon 30 request, make available and disclose to health care professionals writ- 31 ten application procedures and minimum qualification requirements which 32 a health care professional must meet in order to be considered by the 33 insurer for participation in the in-network benefits portion of the 34 insurer's network for the managed care product. The insurer shall 35 consult with appropriately qualified health care professionals in devel- 36 oping its qualification requirements for participation in the in-network 37 benefits portion of the insurer's network for the managed care product. 38 An insurer shall complete review of the health care professional's 39 application to participate in the in-network portion of the insurer's 40 network and, within sixty days of receiving a health care professional's 41 completed application to participate in the insurer's network, will 42 notify the health care professional as to: (A) whether he or she is 43 credentialed; or (B) whether additional time is necessary to make a 44 determination because of a failure of a third party to provide necessary 45 documentation. In such instances where additional time is necessary 46 because of a lack of necessary documentation, an insurer shall make 47 every effort to obtain such information as soon as possible and shall 48 make a final determination within twenty-one days of receiving the 49 necessary documentation. An insurer may not refuse to approve an appli- 50 cation from a physician, who was previously board-certified and who has 51 not maintained such certification, for participation in the in-network 52 portion of the insurer's network solely because such physician is not 53 board-certified. 54 § 4. This act shall take effect immediately.