S T A T E O F N E W Y O R K
________________________________________________________________________
1306
2013-2014 Regular Sessions
I N A S S E M B L Y
(PREFILED)
January 9, 2013
___________
Introduced by M. of A. ZEBROWSKI -- read once and referred to the
Committee on Insurance
AN ACT to amend the insurance law, in relation to imposing a penalty for
failing to comply with notification requirements concerning certain
managed health care products
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Paragraph 1 of subsection (a) of section 4803 of the insur-
ance law, as amended by chapter 237 of the laws of 2009, is amended to
read as follows:
(1) (A) 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)] (I) whether he or
she is credentialed; or [(B)] (II) 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 documenta-
tion, or non-routine or unusual circumstances require additional time
for review. In such instances where additional time is necessary
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD00418-01-3
A. 1306 2
because of a lack of necessary documentation, an insurer shall make
every effort to obtain such information as soon as possible.
(B) IF AN INSURER FAILS TO COMPLY WITH THE NOTIFICATION REQUIREMENTS
IN THIS SECTION WITHIN NINETY DAYS OF RECEIVING A HEALTH CARE PROFES-
SIONAL'S COMPLETED APPLICATION THEN SUCH INSURER WILL BE LIABLE FOR A
CIVIL PENALTY OF FIVE HUNDRED DOLLARS PER DAY PAYABLE TO THE HEALTH CARE
PROFESSIONAL UNTIL SUCH NOTIFICATION REQUIREMENTS PRESCRIBED IN THIS
SECTION ARE MET.
S 2. This act shall take effect immediately.