S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  3450

                       2009-2010 Regular Sessions

                            I N  S E N A T E

                             March 19, 2009
                               ___________

Introduced  by  Sen.  OPPENHEIMER -- 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 the definition of clinical peer reviewer

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1. Subdivision 2 of section 4900 of the public health law, as
amended by chapter 586 of the laws  of  1998,  is  amended  to  read  as
follows:
  2. "Clinical peer reviewer" means:
  (a) [for purposes of title one of this article:
  (i)  a  physician  who  possesses  a  current and valid non-restricted
license to practice medicine; or
  (ii) a health care professional other than a licensed physician who:
  (A) where applicable, possesses a  current  and  valid  non-restricted
license,  certificate  or  registration  or,  where  no  provision for a
license, certificate or registration  exists,  is  credentialed  by  the
national accrediting body appropriate to the profession; and
  (B)  is  in  the  same profession and same or similar specialty as the
health care provider who typically  manages  the  medical  condition  or
disease  or  provides the health care service or treatment under review;
and
  (b) for purposes of title two of this article:
  (i)] a physician who:
  [(A)] (I) possesses a current  and  valid  non-restricted  license  to
practice medicine;
  [(B)]  (II)  where applicable, is board certified or board eligible in
the same or similar specialty as the health care provider who  typically
manages  the  medical  condition  or disease or provides the health care
service or treatment under REVIEW OR appeal;

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD00982-01-9

              

S. 3450                             2

  [(C)] (III) has been practicing in such area of specialty for a period
of at least five years; and
  [(D)] (IV) is knowledgeable about the health care service or treatment
under REVIEW OR appeal; or
  [(ii)]  (B) a health care professional other than a licensed physician
who:
  [(A)] (I) where applicable, possesses a  current  and  valid  non-res-
tricted license, certificate or registration;
  [(B)] (II) where applicable, is credentialed by the national accredit-
ing  body  appropriate to the profession in the same profession and same
or similar specialty as the health care provider who  typically  manages
the  medical condition or disease or provides the health care service or
treatment under REVIEW OR appeal;
  [(C)] (III) has been practicing in such area of specialty for a period
of at least five years;
  [(D)] (IV) is knowledgeable about the health care service or treatment
under REVIEW OR appeal; and
  [(E)] (V) where applicable to such health care professional's scope of
practice, is clinically supported by a physician who possesses a current
and valid non-restricted license to practice medicine.
  [(c)] Nothing [herein] IN  THIS  SUBDIVISION  shall  be  construed  to
change any statutorily-defined scope of practice.
  S  2.  Subsection (b) of section 4900 of the insurance law, as amended
by chapter 586 of the laws of 1998, is amended to read as follows:
  (b) "Clinical peer reviewer" means:
  (1) [for purposes of title one of this article:
  (A) a physician who  possesses  a  current  and  valid  non-restricted
license to practice medicine; or
  (B) a health care professional other than a licensed physician who:
  (i)  where  applicable,  possesses  a current and valid non-restricted
license, certificate or  registration  or,  where  no  provision  for  a
license,  certificate  or  registration  exists,  is credentialed by the
national accrediting body appropriate to the profession; and
  (ii) is in the same profession and same or similar  specialty  as  the
health  care  provider  who  typically  manages the medical condition or
disease or provides the health care service or treatment  under  review;
and
  (2) for purposes of title two of this article:
  (A)] a physician who:
  [(i)]  (A)  possesses  a  current  and valid non-restricted license to
practice medicine;
  [(ii)] (B) where applicable, is board certified or board  eligible  in
the  same or similar specialty as the health care provider who typically
manages the medical condition or disease or  provides  the  health  care
service or treatment under REVIEW OR appeal;
  [(iii)] (C) has been practicing in such area of specialty for a period
of at least five years; and
  [(iv)] (D) is knowledgeable about the health care service or treatment
under REVIEW OR appeal; or
  [(B)]  (2)  a health care professional other than a licensed physician
who:
  [(i)] (A) where applicable, possesses a  current  and  valid  non-res-
tricted license, certificate or registration;
  [(ii)] (B) where applicable, is credentialed by the national accredit-
ing  body  appropriate to the profession in the same profession and same
or similar specialty as the health care provider who  typically  manages

S. 3450                             3

the  medical condition or disease or provides the health care service or
treatment under REVIEW OR appeal;
  [(iii)] (C) has been practicing in such area of specialty for a period
of at least five years;
  [(iv)] (D) is knowledgeable about the health care service or treatment
under REVIEW OR appeal; and
  [(v)] (E) where applicable to such health care professional's scope of
practice, is clinically supported by a physician who possesses a current
and valid non-restricted license to practice medicine.
  [(3)] Nothing [herein] IN THIS SUBSECTION shall be construed to change
any statutorily-defined scope of practice.
  S  3.  This  act shall take effect on the ninetieth day after it shall
have become a law.