S T A T E O F N E W Y O R K
________________________________________________________________________
2693
2013-2014 Regular Sessions
I N A S S E M B L Y
January 17, 2013
___________
Introduced by M. of A. GOTTFRIED, DINOWITZ, GALEF, PAULIN, ROSENTHAL,
SCHIMEL, KAVANAGH, COLTON -- Multi-Sponsored by -- M. of A. JACOBS,
KELLNER -- 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
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.
LBD01580-01-3
A. 2693 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
A. 2693 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.