Assembly Bill A3236

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

                                  3236

                       2009-2010 Regular Sessions

                          I N  A S S E M B L Y

                            January 23, 2009
                               ___________

Introduced  by  M.  of  A.  CHRISTENSEN -- read once and referred to the
  Committee on Insurance

AN ACT to amend the insurance  law,  in  relation  to  the  health  care
  consumer and provider protection and equity

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

  Section 1. The insurance law is amended by adding a new article 80  to
read as follows:
                               ARTICLE 80
         HEALTH CARE CONSUMER AND PROVIDER PROTECTION AND EQUITY
SECTION 8001. LEGISLATIVE FINDINGS.
        8002. DEFINITIONS.
        8003. COLLECTIVE ACTION BY COMPETING PHYSICIANS.
        8004. APPLICATION FOR HEARING.
        8005. FEE FOR REGISTRATION OF AUTHORIZED THIRD PARTIES.
        8006. GOOD FAITH NEGOTIATIONS.
        8007. PROHIBITION OF COLLECTIVE CESSATION OF SERVICES.
        8008. NO INTERFERENCE WITH OTHER STATUTORY RIGHTS.
  S 8001. LEGISLATIVE FINDINGS. THE LEGISLATURE FINDS AND DECLARES THAT:
  (A)  ACTIVE,  ROBUST AND FULLY COMPETITIVE MARKETS FOR HEALTH CARE AND
DENTAL SERVICES PROVIDE THE BEST OPPORTUNITY FOR THE RESIDENTS  OF  THIS
STATE  TO  RECEIVE  HIGH-QUALITY  HEALTH  CARE AND DENTAL SERVICES AT AN
APPROPRIATE COST;
  (B) A SUBSTANTIAL AMOUNT OF HEALTH CARE AND DENTAL  SERVICES  IN  THIS
STATE  IS  PURCHASED  FOR  THE  BENEFIT OF PATIENTS BY HEALTH AND DENTAL
INSURANCE CARRIERS ENGAGED IN THE FINANCING OF HEALTH  CARE  AND  DENTAL
SERVICES  OR  IS  OTHERWISE DELIVERED SUBJECT TO THE TERMS OF AGREEMENTS
BETWEEN CARRIERS AND PHYSICIANS AND DENTISTS;
  (C) CARRIERS ARE ABLE TO CONTROL THE FLOW OF  PATIENTS  TO  PHYSICIANS
AND  DENTISTS  THROUGH  COMPELLING  FINANCIAL INCENTIVES FOR PATIENTS IN

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD05533-01-9

              

A. 3236                             2

THEIR HEALTH AND DENTAL BENEFITS PLANS TO UTILIZE ONLY THE  SERVICES  OF
PHYSICIANS AND DENTISTS WITH WHOM THE CARRIERS HAVE CONTRACTED;
  (D) CARRIERS ALSO CONTROL THE HEALTH CARE AND DENTAL SERVICES RENDERED
TO  PATIENTS THROUGH UTILIZATION MANAGEMENT AND OTHER MANAGED CARE TOOLS
AND ASSOCIATED COVERAGE AND PAYMENT POLICIES;
  (E) CARRIERS ARE OFTEN ABLE TO VIRTUALLY  DICTATE  THE  TERMS  OF  THE
CONTRACTS  THAT  THEY  OFFER  PHYSICIANS AND DENTISTS AND COMMONLY OFFER
THESE CONTRACTS ON A TAKE-IT-OR-LEAVE-IT BASIS;
  (F) THE POWER OF CARRIERS TO  UNILATERALLY  IMPOSE  PROVIDER  CONTRACT
TERMS  JEOPARDIZES THE ABILITY OF PHYSICIANS AND DENTISTS TO DELIVER THE
SUPERIOR QUALITY HEALTH CARE AND DENTAL SERVICES TRADITIONALLY AVAILABLE
IN THIS STATE;
  (G) PHYSICIANS AND DENTISTS DO NOT HAVE  SUFFICIENT  MARKET  POWER  TO
REJECT  UNFAIR  PROVIDER  CONTRACT TERMS OFFERED BY CARRIERS THAT IMPEDE
THEIR ABILITY TO DELIVER MEDICALLY APPROPRIATE CARE WITHOUT UNDUE  DELAY
OR DIFFICULTIES;
  (H) INADEQUATE REIMBURSEMENT AND OTHER UNFAIR PAYMENT TERMS OFFERED BY
CARRIERS ADVERSELY AFFECT THE QUALITY OF PATIENT CARE AND ACCESS TO CARE
BY  REDUCING  THE  RESOURCES  THAT PHYSICIANS AND DENTISTS CAN DEVOTE TO
PATIENT CARE AND DECREASING THE TIME THAT PHYSICIANS  AND  DENTISTS  ARE
ABLE TO SPEND WITH THEIR PATIENTS;
  (I)  INEQUITABLE  REIMBURSEMENT  AND  OTHER  UNFAIR PAYMENT TERMS ALSO
ENDANGER THE HEALTH CARE INFRASTRUCTURE AND MEDICAL PROGRESS BY  DIVERT-
ING  CAPITAL NEEDED FOR REINVESTMENT IN THE HEALTH CARE DELIVERY SYSTEM,
CURTAILING THE PURCHASE OF STATE-OF-THE-ART TECHNOLOGY, THE  PURSUIT  OF
MEDICAL  RESEARCH,  AND EXPANSION OF MEDICAL SERVICES, ALL TO THE DETRI-
MENT OF THE RESIDENTS OF THIS STATE;
  (J) THE INEVITABLE COLLATERAL REDUCTION AND MIGRATION  OF  THE  HEALTH
CARE  WORK FORCE WILL ALSO HAVE NEGATIVE CONSEQUENCES FOR THE ECONOMY OF
THIS STATE;
  (K) EMPOWERING INDEPENDENT PHYSICIANS AND DENTISTS TO JOINTLY  NEGOTI-
ATE  WITH  CARRIERS  AS  PROVIDED  IN THIS ARTICLE WILL HELP RESTORE THE
COMPETITIVE BALANCE AND IMPROVE COMPETITION IN THE  MARKETS  FOR  HEALTH
CARE  AND  DENTAL SERVICES IN THIS STATE, THEREBY PROVIDING BENEFITS FOR
CONSUMERS, PHYSICIANS AND DENTISTS AND LESS DOMINANT CARRIERS;
  (L) THIS ARTICLE IS NECESSARY AND PROPER, AND CONSTITUTES AN APPROPRI-
ATE EXERCISE OF THE AUTHORITY OF THIS STATE TO REGULATE THE BUSINESS  OF
INSURANCE AND THE DELIVERY OF HEALTH CARE AND DENTAL SERVICES;
  (M)  THE  PRO-COMPETITIVE AND OTHER BENEFITS OF THE JOINT NEGOTIATIONS
AND RELATED JOINT ACTIVITY AUTHORIZED BY THIS  ARTICLE,  INCLUDING,  BUT
NOT  LIMITED  TO,  RESTORING  THE  COMPETITIVE BALANCE IN THE MARKET FOR
HEALTH CARE SERVICES, PROTECTING ACCESS TO QUALITY PATIENT CARE, PROMOT-
ING THE HEALTH CARE INFRASTRUCTURE AND MEDICAL PROGRESS,  AND  IMPROVING
COMMUNICATIONS,  OUTWEIGH ANY POTENTIAL ANTI-COMPETITIVE EFFECTS OF THIS
ARTICLE; AND
  (N) IT IS THE INTENTION OF THE LEGISLATURE  TO  AUTHORIZE  INDEPENDENT
PHYSICIANS AND DENTISTS TO JOINTLY NEGOTIATE WITH CARRIERS AND TO QUALI-
FY  SUCH  JOINT  NEGOTIATIONS  AND  RELATED  JOINT  ACTIVITIES  FOR  THE
STATE-ACTION EXEMPTION TO THE FEDERAL ANTITRUST LAWS THROUGH THE  ARTIC-
ULATED STATE POLICY AND ACTIVE SUPERVISION PROVIDED UNDER THIS ARTICLE.
  S 8002. DEFINITIONS. AS USED IN THIS ARTICLE,
  (A)  "AUTHORIZED  THIRD PARTY" MEANS A PERSON AUTHORIZED BY THE PHYSI-
CIANS TO NEGOTIATE ON THEIR BEHALF WITH A HEALTH BENEFIT PLAN UNDER THIS
CHAPTER; AND

A. 3236                             3

  (B) "HEALTH CARE PLAN"  AS  DEFINED  IN  SECTION  FOUR  THOUSAND  NINE
HUNDRED  OF THIS CHAPTER BUT DOES NOT INCLUDE A SELF-INSURED HEALTH CARE
PLAN.
  S  8003.  COLLECTIVE  ACTION  BY  COMPETING  PHYSICIANS. (A) COMPETING
PHYSICIANS MAY MEET AND COMMUNICATE IN ORDER TO  COLLECTIVELY  NEGOTIATE
WITH  A  HEALTH  BENEFIT  PLAN  CONCERNING ANY OF THE CONTRACT TERMS AND
CONDITIONS DESCRIBED IN THIS SECTION, BUT MAY NOT NEGOTIATE  THE  EXCLU-
SION  OF PROVIDERS WHO ARE NON-PHYSICIANS FROM DIRECT REIMBURSEMENT BY A
HEALTH BENEFIT PLAN, AND MAY NOT NEGOTIATE THE SETTING IN WHICH  PROVID-
ERS  WHO  ARE  NON-PHYSICIANS DELIVER SERVICES. COMPETING PHYSICIANS MAY
NOT ENGAGE IN A BOYCOTT RELATED TO THESE TERMS AND CONDITIONS. COMPETING
PHYSICIANS MAY MEET AND COMMUNICATE CONCERNING:
  (1) PHYSICIAN CLINICAL PRACTICE GUIDELINES AND COVERAGE CRITERIA;
  (2) THE RESPECTIVE LIABILITY OF PHYSICIANS AND THE HEALTH BENEFIT PLAN
FOR THE TREATMENT OR LACK OF TREATMENT OF INSURED OR ENROLLED PERSONS;
  (3) ADMINISTRATIVE PROCEDURES, INCLUDING METHODS  AND  TIMING  OF  THE
PAYMENT OF SERVICES TO PHYSICIANS;
  (4) PROCEDURES FOR THE RESOLUTION OF DISPUTES BETWEEN THE HEALTH BENE-
FIT PLAN AND PHYSICIANS;
  (5) PATIENT REFERRAL PROCEDURES;
  (6) THE FORMULATION AND APPLICATION OF REIMBURSEMENT METHODOLOGY;
  (7) QUALITY ASSURANCE PROGRAMS;
  (8) HEALTH SERVICE UTILIZATION REVIEW PROCEDURES; AND
  (9)  CRITERIA TO BE USED BY HEALTH BENEFIT PLANS FOR THE SELECTION AND
TERMINATION OF PHYSICIANS, INCLUDING  WHETHER  TO  ENGAGE  IN  SELECTIVE
CONTRACTING.
  (B)  AN AUTHORIZED THIRD PARTY THAT INTENDS TO NEGOTIATE WITH A HEALTH
BENEFIT PLAN THE ITEMS IDENTIFIED UNDER SUBSECTION (A) OF  THIS  SECTION
SHALL PROVIDE THE INDEPENDENT REVIEW PANEL, AS ESTABLISHED BY SUBSECTION
(C)  OF  THIS  SECTION, WITH WRITTEN NOTICE OF THE INTENDED NEGOTIATIONS
BEFORE THE NEGOTIATIONS BEGIN.
  (C) THE INDEPENDENT REVIEW PANEL SHALL CONSIST OF THREE MEMBERS:
  (1) THE ATTORNEY GENERAL, OR  HIS  OR  HER  DESIGNEE  WHO  SHALL  HAVE
PARTICULAR EXPERTISE IN THE AREA OF ANTITRUST LAW;
  (2) THE STATE COMMISSIONER OF HEALTH, OR HIS OR HER DESIGNEE; AND
  (3) THE STATE COMMISSIONER OF LABOR, OR HIS OR HER DESIGNEE.
  (D)  IN  EXERCISING THE COLLECTIVE RIGHTS GRANTED BY SUBSECTION (A) OF
THIS SECTION:
  (1) PHYSICIANS MAY COMMUNICATE WITH EACH OTHER  WITH  RESPECT  TO  THE
CONTRACTUAL  TERMS AND CONDITIONS TO BE NEGOTIATED WITH A HEALTH BENEFIT
PLAN;
  (2) PHYSICIANS MAY COMMUNICATE WITH AN AUTHORIZED THIRD PARTY  REGARD-
ING THE TERMS AND CONDITIONS OF CONTRACTS ALLOWED UNDER THIS SECTION;
  (3) THE AUTHORIZED THIRD PARTY IS THE SOLE PARTY AUTHORIZED TO NEGOTI-
ATE  WITH  A  HEALTH BENEFIT PLAN ON BEHALF OF A DEFINED GROUP OF PHYSI-
CIANS;
  (4) PHYSICIANS CAN BE BOUND BY THE TERMS AND CONDITIONS NEGOTIATED  BY
THE AUTHORIZED THIRD PARTY THAT REPRESENTS THEIR INTERESTS;
  (5)  A  HEALTH  BENEFIT  PLAN  COMMUNICATING  OR  NEGOTIATING WITH THE
AUTHORIZED THIRD PARTY MAY CONTRACT WITH, OR  OFFER  DIFFERENT  CONTRACT
TERMS AND CONDITIONS TO, INDIVIDUAL COMPETING PHYSICIANS;
  (6)  AN  AUTHORIZED  THIRD  PARTY  MAY  NOT REPRESENT MORE THAN THIRTY
PERCENT OF THE MARKET OF PRACTICING  PHYSICIANS  FOR  THE  PROVISION  OF
SERVICES  IN  THE GEOGRAPHIC SERVICE AREA OR PROPOSED GEOGRAPHIC SERVICE
AREA, IF THE HEALTH BENEFIT PLAN HAS LESS THAN  A  FIVE  PERCENT  MARKET
SHARE  AS  DETERMINED  BY THE NUMBER OF COVERED LIVES AS REPORTED BY THE

A. 3236                             4

SUPERINTENDENT FOR THE MOST RECENTLY COMPLETED CALENDAR YEAR OR  BY  THE
ACTUAL  NUMBER OF CONSUMERS OF PREPAID COMPREHENSIVE HEALTH SERVICES; IN
THIS PARAGRAPH, "COVERED LIVES" MEANS THE TOTAL  NUMBER  OF  INDIVIDUALS
WHO ARE ENTITLED TO BENEFITS UNDER THE HEALTH BENEFIT PLAN;
  (7)  THE INDEPENDENT REVIEW PANEL MAY LIMIT THE PERCENTAGE OF PRACTIC-
ING PHYSICIANS REPRESENTED BY AN AUTHORIZED THIRD  PARTY;  HOWEVER,  THE
LIMITATION MAY NOT BE LESS THAN THIRTY PERCENT OF THE MARKET OF PRACTIC-
ING  PHYSICIANS  IN  THE  GEOGRAPHIC SERVICE AREA OR PROPOSED GEOGRAPHIC
SERVICE AREA; WHEN DETERMINING WHETHER TO IMPOSE A LIMITATION  DESCRIBED
UNDER THIS PARAGRAPH, THE ATTORNEY GENERAL SHALL CONSIDER THE PROVISIONS
DESCRIBED UNDER SUBSECTIONS (F), (G) AND (H) OF THIS SECTION; THIS PARA-
GRAPH  DOES  NOT  APPLY  IF  THE  MARKET OF PRACTICING PHYSICIANS IN THE
GEOGRAPHIC SERVICE AREA OR PROPOSED GEOGRAPHIC SERVICE AREA CONSISTS  OF
FORTY OR FEWER INDIVIDUALS; AND
  (8)  THE  AUTHORIZED  THIRD  PARTY SHALL COMPLY WITH THE PROVISIONS OF
SUBSECTION (E) OF THIS SECTION.
  (E) A PERSON ACTING OR PROPOSING TO ACT AS AN AUTHORIZED  THIRD  PARTY
UNDER THIS SECTION SHALL:
  (1)  BEFORE  ENGAGING IN COLLECTIVE NEGOTIATIONS WITH A HEALTH BENEFIT
PLAN:
  (A) FILE WITH THE INDEPENDENT REVIEW PANEL THE INFORMATION THAT  IDEN-
TIFIES  THE  AUTHORIZED  THIRD  PARTY, THE PHYSICIANS REPRESENTED BY THE
THIRD PARTY, THE AUTHORIZED THIRD PARTY'S PLAN  OF  OPERATION,  AND  THE
AUTHORIZED  THIRD  PARTY'S  PROCEDURES  TO  ENSURE  COMPLIANCE WITH THIS
SECTION;
  (B) FURNISH TO THE INDEPENDENT REVIEW PANEL FOR ITS APPROVAL, A  BRIEF
REPORT  THAT  IDENTIFIES THE PROPOSED SUBJECT MATTER OF THE NEGOTIATIONS
OR DISCUSSIONS WITH A HEALTH BENEFIT PLAN AND THAT CONTAINS AN  EXPLANA-
TION  OF  THE  EFFICIENCIES OR BENEFITS THAT ARE EXPECTED TO BE ACHIEVED
THROUGH THE COLLECTIVE NEGOTIATIONS, PRODUCT AND GEOGRAPHIC MARKET DEFI-
NITION, CURRENT PRICE LEVELS, AVAILABILITY OR SUBSTITUTES, AND  EASE  OF
ENTRY FOR NEW COMPETING PHYSICIANS;
  (C)  THE  INDEPENDENT  REVIEW  PANEL SHALL REVIEW WHETHER THE GROUP OF
PHYSICIANS REPRESENTED BY THE AUTHORIZED THIRD PARTY IS  APPROPRIATE  TO
REPRESENT  THE  INTERESTS  INVOLVED IN THE NEGOTIATIONS; THE INDEPENDENT
REVIEW PANEL MAY NOT APPROVE THE REPORT IF THE GROUP  OF  PHYSICIANS  IS
NOT  APPROPRIATE TO REPRESENT THE INTERESTS INVOLVED IN THE NEGOTIATIONS
OR IF THE PROPOSED NEGOTIATIONS EXCEED THE  AUTHORITY  GRANTED  IN  THIS
ARTICLE  AND, IF THE GROUP IS NOT APPROPRIATE OR THE NEGOTIATIONS EXCEED
THE GRANTED AUTHORITY, SHALL  PROVIDE  WRITTEN  NOTICE  PROHIBITING  THE
COLLECTIVE  NEGOTIATIONS  FROM  PROCEEDING,  AT  WHICH TIME THE PROPOSED
AUTHORIZED THIRD PARTY MAY REQUEST A HEARING PURSUANT TO  SECTION  EIGHT
THOUSAND FOUR OF THIS ARTICLE.
  (D)  THE AUTHORIZED THIRD PARTY SHALL PROVIDE SUPPLEMENTAL INFORMATION
TO THE INDEPENDENT REVIEW PANEL AS  NEW  INFORMATION  BECOMES  AVAILABLE
THAT  INDICATES  THAT THE SUBJECT MATTER OF NEGOTIATIONS WITH THE HEALTH
BENEFIT PLAN HAS CHANGED OR WILL CHANGE; THE  INDEPENDENT  REVIEW  PANEL
MAY, AS IT DEEMS APPROPRIATE, REQUEST ADDITIONAL INFORMATION IN ORDER TO
ASSESS  THE  LIKELY COMPETITIVE EFFECTS OF NEGOTIATIONS; THE INDEPENDENT
REVIEW PANEL MAY ALSO SOLICIT  INPUT  FROM  OTHER  PHYSICIANS,  AFFECTED
HEALTH  PLANS,  AND PATIENTS REGARDING THE POTENTIAL COMPETITIVE EFFECTS
OF NEGOTIATIONS;
  (E) WITHIN FOURTEEN DAYS AFTER RECEIVING A HEALTH BENEFIT PLAN'S DECI-
SION TO DECLINE TO NEGOTIATE OR TO  TERMINATE  NEGOTIATIONS,  OR  WITHIN
FOURTEEN  DAYS  AFTER REQUESTING NEGOTIATIONS WITH A HEALTH BENEFIT PLAN

A. 3236                             5

THAT FAILS TO RESPOND WITHIN THAT TIME, REPORT TO THE  ATTORNEY  GENERAL
THAT NEGOTIATIONS HAVE ENDED OR HAVE BEEN DECLINED;
  (2) WHILE NEGOTIATING WITH A HEALTH BENEFIT PLAN:
  (A)  PROVIDE THE INDEPENDENT REVIEW PANEL, UPON THE INDEPENDENT REVIEW
PANEL'S REQUEST, WITH COPIES OF  ALL  WRITTEN  COMMUNICATIONS  THAT  ARE
RELEVANT  TO THE NEGOTIATIONS, THAT ARE IN THE POSSESSION OF THE AUTHOR-
IZED THIRD PARTY, AND THAT ARE BETWEEN:
  (I) PHYSICIANS AND THE HEALTH BENEFIT PLAN,
  (II) PHYSICIANS AND AUTHORIZED THIRD PARTIES,
  (III) AUTHORIZED THIRD PARTIES AND HEALTH PLANS,
  (IV) THE INDIVIDUAL PHYSICIANS, AND
  (V) AUTHORIZED THIRD PARTIES;
  (B) BEFORE REPORTING THE RESULTS OF NEGOTIATIONS WITH A HEALTH BENEFIT
PLAN AND BEFORE GIVING PHYSICIANS AN EVALUATION OF ANY OFFER MADE  BY  A
HEALTH  BENEFIT  PLAN,  PROVIDE  TO THE INDEPENDENT REVIEW PANEL FOR ITS
APPROVAL, A COPY OF ALL COMMUNICATIONS TO BE MADE TO PHYSICIANS  RELATED
TO THE NEGOTIATIONS, DISCUSSIONS, AND HEALTH BENEFIT PLAN OFFERS.
  (3) BE AN ORGANIZATION THAT REPRESENTS BOTH CONSUMERS AND PROVIDERS OF
HEALTH CARE.
  (F)  THE  INDEPENDENT  REVIEW PANEL SHALL EITHER APPROVE OR DISAPPROVE
THE CONTRACT THAT WAS THE SUBJECT OF THE COLLECTIVE  NEGOTIATION  WITHIN
SIXTY  DAYS AFTER RECEIVING THE REPORTS REQUIRED UNDER SUBSECTION (E) OF
THIS SECTION. IF THE CONTRACT IS  DISAPPROVED,  THE  INDEPENDENT  REVIEW
PANEL  SHALL  FURNISH A WRITTEN EXPLANATION. UPON DISAPPROVAL, THE INDE-
PENDENT REVIEW PANEL SHALL DENOTE ANY DEFICIENCIES ALONG WITH  A  STATE-
MENT  OF  SPECIFIC  REMEDIAL  MEASURES THAT WOULD CORRECT ANY IDENTIFIED
DEFICIENCIES. AN AUTHORIZED THIRD PARTY WHO FAILS TO  OBTAIN  THE  INDE-
PENDENT  REVIEW  PANEL'S APPROVAL IS CONSIDERED TO BE ACTING OUTSIDE THE
AUTHORITY OF THIS SECTION.
  (G) THE INDEPENDENT REVIEW PANEL SHALL APPROVE  A  COLLECTIVE  NEGOTI-
ATION CONTRACT IF:
  (1)  THE COMPETITIVE AND OTHER BENEFITS OF THE CONTRACT TERMS OUTWEIGH
ANY ANTICOMPETITIVE EFFECTS; AND
  (2) THE CONTRACT TERMS ARE CONSISTENT WITH OTHER APPLICABLE  LAWS  AND
REGULATIONS.
  (H)  THE COMPETITIVE AND OTHER BENEFITS OF JOINT NEGOTIATIONS OR NEGO-
TIATED PROVIDER CONTRACT TERMS MUST INCLUDE:
  (1) RESTORATION OF THE COMPETITIVE BALANCE IN THE  MARKET  FOR  HEALTH
CARE SERVICES;
  (2) PROTECTIONS FOR ACCESS TO QUALITY PATIENT CARE;
  (3)  PROMOTION  OF HEALTH CARE INFRASTRUCTURE AND MEDICAL ADVANCEMENT;
OR
  (4) IMPROVED COMMUNICATION BETWEEN HEALTH CARE  PROVIDERS  AND  HEALTH
CARE INSURERS.
  (I)  WHEN  WEIGHING THE ANTICOMPETITIVE EFFECTS OF CONTRACT TERMS, THE
INDEPENDENT REVIEW PANEL SHALL CONSIDER WHETHER THE TERMS:
  (1) PROVIDE FOR EXCESSIVE PAYMENTS; OR
  (2) CONTRIBUTE TO THE ESCALATION OF THE COST OF PROVIDING HEALTH  CARE
SERVICES.
  (J)  THIS  SECTION  DOES  NOT AUTHORIZE COMPETING PHYSICIANS TO ACT IN
CONCERT IN RESPONSE TO A REPORT ISSUED  BY  AN  AUTHORIZED  THIRD  PARTY
RELATED  TO THE AUTHORIZED THIRD PARTY'S DISCUSSION OR NEGOTIATIONS WITH
A HEALTH BENEFIT PLAN. THE  AUTHORIZED  THIRD  PARTY  SHALL  ADVISE  THE
PHYSICIANS  OF  THE PROVISIONS OF THIS SUBSECTION AND SHALL WARN THEM OF
THE POTENTIAL FOR LEGAL ACTION AGAINST THOSE WHO VIOLATE STATE OR FEDER-
AL ANTITRUST LAWS BY EXCEEDING THE AUTHORITY GRANTED UNDER THIS SECTION.

A. 3236                             6

  (K) A CONTRACT ALLOWED UNDER THIS SECTION MAY NOT  EXCEED  A  TERM  OF
FIVE YEARS.
  (L) THE DOCUMENTS RELATING TO A COLLECTIVE NEGOTIATION DESCRIBED UNDER
THIS  SECTION  THAT  ARE  IN THE POSSESSION OF THE DEPARTMENT OF LAW ARE
CONFIDENTIAL AND NOT OPEN TO PUBLIC INSPECTION.
  (M) NOTHING IN THIS SECTION SHALL BE CONSTRUED AS EXEMPTING  FROM  THE
APPLICATION  OF  THE  ANTITRUST LAWS THE CONDUCT OF PROVIDERS OR NEGOTI-
ATIONS OR AGREEMENTS BETWEEN PROVIDERS AND A HEALTH BENEFIT PLAN IF  THE
PURPOSE  OR EFFECT OF THE CONDUCT, NEGOTIATIONS, OR AGREEMENTS WOULD BE,
DIRECTLY  OR  INDIRECTLY,  TO  EXCLUDE,  LIMIT  THE   PARTICIPATION   OR
REIMBURSEMENT  OF,  OR  OTHERWISE  LIMIT  THE  SCOPE  OF  SERVICES TO BE
PROVIDED BY SEPARATE OR COMPETING CLASSES OF PROVIDERS WHO  PRACTICE  OR
SEEK  TO  PRACTICE WITHIN THE SCOPE OF THE OCCUPATIONAL LICENSES HELD BY
THE PROVIDERS.
  (N) IN THIS SECTION "GEOGRAPHIC SERVICE  AREA"  MEANS  THE  GEOGRAPHIC
AREA OF THE PHYSICIANS SEEKING TO JOINTLY NEGOTIATE.
  S 8004. APPLICATION FOR HEARING. (A) WITHIN THIRTY DAYS FROM THE MAIL-
ING  BY  THE INDEPENDENT REVIEW PANEL OF THE NOTICE OF DISAPPROVAL OF AN
APPLICATION BY A PROPOSED AUTHORIZED THIRD  PARTY  REPRESENTATIVE  UNDER
PARAGRAPH  ONE OF SUBSECTION (E) OF SECTION EIGHT THOUSAND THREE OF THIS
ARTICLE, SAID REPRESENTATIVE MAY MAKE A WRITTEN APPLICATION TO THE INDE-
PENDENT REVIEW PANEL FOR A HEARING, THE SOLE PURPOSE OF WHICH  WOULD  BE
TO REVIEW THE INDEPENDENT REVIEW PANEL'S DISAPPROVAL.
  (B)  UPON RECEIPT OF A TIMELY APPLICATION FOR A HEARING, THE INDEPEND-
ENT REVIEW PANEL SHALL SCHEDULE AND CONDUCT AN  ADMINISTRATIVE  HEARING.
THE  HEARING  SHALL BE HELD WITHIN THIRTY DAYS OF THE APPLICATION UNLESS
THE REPRESENTATIVE SEEKS AN EXTENSION.
  (C) THE INDEPENDENT REVIEW PANEL SHALL APPOINT A NEUTRAL HEARING OFFI-
CER TO PRESIDE OVER THE HEARING.
  S 8005. FEE FOR REGISTRATION OF  AUTHORIZED  THIRD  PARTIES.  (A)  THE
INDEPENDENT  REVIEW  PANEL  SHALL  ADOPT  REGULATIONS THAT ESTABLISH THE
AMOUNT AND MANNER OF PAYMENT OF A REGISTRATION FEE FOR AUTHORIZED  THIRD
PARTIES.  THE  INDEPENDENT REVIEW PANEL SHALL ESTABLISH THE FEE LEVEL SO
THAT THE TOTAL AMOUNT OF FEES COLLECTED FROM  AUTHORIZED  THIRD  PARTIES
APPROXIMATELY  EQUALS  THE  ACTUAL REGULATORY COSTS FOR THE OVERSIGHT OF
JOINT NEGOTIATIONS BETWEEN PHYSICIANS  AND  HEALTH  BENEFIT  PLANS.  THE
INDEPENDENT  REVIEW  PANEL SHALL ANNUALLY REVIEW THE FEE LEVEL TO DETER-
MINE WHETHER  THE  REGULATORY  COSTS  ARE  APPROXIMATELY  EQUAL  TO  FEE
COLLECTIONS.  IF THE REVIEW INDICATES THAT THE FEE COLLECTIONS AND REGU-
LATORY COSTS ARE NOT APPROXIMATELY EQUAL, THE INDEPENDENT  REVIEW  PANEL
SHALL  CALCULATE  FEE  ADJUSTMENTS  AND  ADOPT  REGULATIONS  UNDER  THIS
SUBSECTION TO IMPLEMENT THE ADJUSTMENTS. IN JANUARY OF  EACH  YEAR,  THE
INDEPENDENT REVIEW PANEL SHALL REPORT ON THE FEE LEVEL AND REVISIONS FOR
THE PREVIOUS YEAR UNDER THIS SUBSECTION TO THE DEPARTMENT.
  (B)  FOR  PURPOSES  OF THIS SECTION, "REGULATORY COSTS" MEANS COSTS OF
THE INDEPENDENT REVIEW PANEL THAT ARE ATTRIBUTED TO OVERSIGHT  OF  JOINT
NEGOTIATIONS BETWEEN PHYSICIANS AND HEALTH BENEFIT PLANS.
  S  8006. GOOD FAITH NEGOTIATIONS. A HEALTH BENEFIT PLAN AND AN AUTHOR-
IZED THIRD PARTY SHALL NEGOTIATE IN GOOD FAITH REGARDING THE  TERMS  AND
CONDITIONS OF PHYSICIAN OR DENTIST CONTRACTS PURSUANT TO THIS ARTICLE.
  S   8007.   PROHIBITION  OF  COLLECTIVE  CESSATION  OF  SERVICES.  THE
PROVISIONS OF THIS ARTICLE SHALL NOT BE CONSTRUED TO PERMIT TWO OR  MORE
PHYSICIANS  OR  DENTISTS  TO  JOINTLY ENGAGE IN A COORDINATED CESSATION,
REDUCTION OR LIMITATION OF THE  HEALTH  CARE  OR  DENTAL  SERVICES  THEY
PROVIDE.

A. 3236                             7

  S 8008. NO INTERFERENCE WITH OTHER STATUTORY RIGHTS. THE PROVISIONS OF
THIS  ARTICLE SHALL NOT AFFECT THE COLLECTIVE BARGAINING RIGHTS AN INDI-
VIDUAL PROVIDER MAY  OTHERWISE  HAVE  PURSUANT  TO  THE  NATIONAL  LABOR
RELATIONS  ACT,  29 U.S.C. S 151, ET SEQ.; NEW YORK STATE PUBLIC EMPLOY-
EES'  FAIR EMPLOYMENT ACT, ARTICLE FOURTEEN OF THE CIVIL SERVICE LAW; OR
ANY OTHER STATUTE.
  S 2. This act shall take effect on the one hundred eightieth day after
it shall have become a law. Effective immediately the attorney general's
office shall promulgate any and all rules and regulations and  take  any
other measures necessary to implement this act on its effective date, on
or before such date.