Bill Text: NY S07357 | 2017-2018 | General Assembly | Amended

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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 (Republican 1-0)

Status: (Introduced - Dead) 2018-05-03 - PRINT NUMBER 7357A [S07357 Detail]

Download: New_York-2017-S07357-Amended.html

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                STATE OF NEW YORK
        ________________________________________________________________________
                                         7357--A
                    IN SENATE
                                     January 9, 2018
                                       ___________
        Introduced  by  Sen.  DeFRANCISCO -- read twice and ordered printed, and
          when printed to be committed to the Committee on Health  --  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:
     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.
                                                                   LBD09068-07-8
        S. 7357--A                          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.