Assembly Bill A8979

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

                                  8979

                          I N  A S S E M B L Y

                              March 6, 2014
                               ___________

Introduced  by  M.  of  A.  SCHIMMINGER -- read once and referred 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:

  Section 1. Subdivision 1 of section 2801-b of the public  health  law,
as  amended  by  chapter  605 of the laws of 2008, is amended to read as
follows:
  1. It shall be an improper practice for the governing body of a hospi-
tal to refuse to act upon an application for staff membership or profes-
sional privileges or to deny or withhold from a  physician,  podiatrist,
optometrist,  dentist  or  licensed  midwife staff membership or profes-
sional privileges in a hospital, or to exclude  or  expel  a  physician,
podiatrist,  optometrist, dentist or licensed midwife from staff member-
ship in a hospital or curtail, terminate or diminish in any way a physi-
cian's, podiatrist's, optometrist's,  dentist's  or  licensed  midwife's
professional  privileges  in  a  hospital,  without  stating the reasons
therefor, or if the reasons stated are unrelated to standards of patient
care, patient welfare, the objectives of the institution or the  charac-
ter or competency of the applicant. It shall be an improper practice for
a  governing  body of a hospital to refuse to act upon an application or
to deny or to withhold staff membership or professional privileges to  a
podiatrist  based solely upon a practitioner's category of licensure. IT
SHALL BE AN IMPROPER PRACTICE FOR A GOVERNING  BODY  OF  A  HOSPITAL  TO
REFUSE  TO  ACT  UPON  AN  APPLICATION  OR  TO DENY OR TO WITHHOLD STAFF
MEMBERSHIP OR PROFESSIONAL PRIVILEGES OF A PHYSICIAN SOLELY BECAUSE SUCH
PHYSICIAN IS NOT BOARD-CERTIFIED.
  S 2. Paragraph (a) of subdivision 1 of section 4406-d  of  the  public
health law, as amended by chapter 237 of the laws of 2009, is amended to
read as follows:
  (a)  A  health  care  plan  shall,  upon  request,  make available and
disclose to health care professionals written application procedures and

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

                                                           LBD14123-01-4

A. 8979                             2

minimum qualification requirements which a health care professional must
meet in order to be considered by the health care plan. The  plan  shall
consult with appropriately qualified health care professionals in devel-
oping  its qualification requirements. A health care plan shall complete
review of the health care professional's application to  participate  in
the  in-network  portion  of  the  health care plan's network and shall,
within ninety days of receiving a health care  professional's  completed
application to participate in the health care plan's network, notify the
health  care  professional as to: (i) whether he or she is credentialed;
or (ii) whether additional time is necessary to make a determination  in
spite  of the health care plan's best efforts or because of a failure of
a third party to provide  necessary  documentation,  or  non-routine  or
unusual  circumstances  require  additional  time  for  review.  In such
instances where additional time is necessary because of a lack of neces-
sary documentation, a health plan shall make every effort to obtain such
information as soon as possible. A HEALTH CARE PLAN MAY  NOT  REFUSE  TO
APPROVE AN APPLICATION FROM A PHYSICIAN TO PARTICIPATE IN THE IN-NETWORK
PORTION  OF THE HEALTH CARE PLAN'S NETWORK SOLELY BECAUSE SUCH PHYSICIAN
IS NOT BOARD-CERTIFIED.
  S 3. Paragraph 1 of subsection (a) of section 4803  of  the  insurance
law,  as  amended by chapter 237 of the laws of 2009, is amended to read
as follows:
  (1) An insurer  which  offers  a  managed  care  product  shall,  upon
request,  make available and disclose to health care professionals writ-
ten application procedures and minimum qualification requirements  which
a  health  care  professional must meet in order to be considered by the
insurer for participation in the  in-network  benefits  portion  of  the
insurer's  network  for  the  managed  care  product.  The insurer shall
consult with appropriately qualified health care professionals in devel-
oping its qualification requirements for participation in the in-network
benefits portion of the insurer's network for the managed care  product.
An  insurer  shall  complete  review  of  the health care professional's
application to participate in the in-network portion  of  the  insurer's
network  and,  within  ninety  days  of  receiving a health care profes-
sional's completed application to participate in the insurer's  network,
will notify the health care professional as to: (A) whether he or she is
credentialed;  or  (B)  whether  additional  time is necessary to make a
determination in spite of the insurer's best efforts  or  because  of  a
failure  of  a  third  party to provide necessary documentation, or non-
routine or unusual circumstances require additional time for review.  In
such instances where additional time is necessary because of a  lack  of
necessary  documentation,  an  insurer shall make every effort to obtain
such information as soon as possible.  AN  INSURER  MAY  NOT  REFUSE  TO
APPROVE AN APPLICATION FROM A PHYSICIAN FOR PARTICIPATION IN THE IN-NET-
WORK  PORTION  OF THE INSURER'S NETWORK SOLELY BECAUSE SUCH PHYSICIAN IS
NOT BOARD-CERTIFIED.
  S 4. This act shall take effect immediately.