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

                                   662

                       2011-2012 Regular Sessions

                          I N  A S S E M B L Y

                               (PREFILED)

                             January 5, 2011
                               ___________

Introduced  by  M.  of  A. GOTTFRIED, DINOWITZ, GALEF, KAVANAGH, PAULIN,
  SCHIMEL -- Multi-Sponsored by -- M. of A. JACOBS, KELLNER,  J. MILLER,
  TOWNS -- read once and referred 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

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD02275-01-1
              

A. 662                              2

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; 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;

A. 662                              3

  [(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
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.