senate Bill S5155

2013-2014 Legislative Session

Relates to the provisional credentialing of physicians

download bill text pdf

Sponsored By

Archive: Last Bill Status - In Senate Committee


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor

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Actions

view actions (2)
Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Jan 08, 2014 referred to insurance
May 13, 2013 referred to insurance

S5155 - Details

See Assembly Version of this Bill:
A7569
Law Section:
Insurance Law
Laws Affected:
Amd §4803, Ins L; amd §4406-d, Pub Health L

S5155 - Summary

Relates to the provisional credentialing of physicians.

S5155 - Sponsor Memo

S5155 - Bill Text download pdf

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

                                  5155

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                              May 13, 2013
                               ___________

Introduced  by  Sen. VALESKY -- read twice and ordered printed, and when
  printed to be committed to the Committee on Insurance

AN ACT to amend the insurance law and the public health law, in relation
  to provider credentialing

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

  Section  1.  Subsection  (a)  of  section 4803 of the insurance law is
amended by adding a new paragraph 3 to read as follows:
  (3) A NEWLY-LICENSED PHYSICIAN, A PHYSICIAN WHO HAS RECENTLY RELOCATED
TO THIS STATE FROM ANOTHER STATE AND HAS  NOT  PREVIOUSLY  PRACTICED  IN
THIS  STATE,  OR  A  PHYSICIAN  WHO  HAS  CHANGED  HIS  OR HER CORPORATE
RELATIONSHIP SUCH THAT IT RESULTS IN THE ISSUANCE OF A NEW TAX IDENTIFI-
CATION NUMBER UNDER WHICH SUCH PHYSICIAN'S SERVICES ARE BILLED FOR,  WHO
IS   EMPLOYED  BY  A  GENERAL  HOSPITAL  LICENSED  PURSUANT  TO  ARTICLE
TWENTY-EIGHT OF THE PUBLIC HEALTH LAW, AND WHOSE OTHER  EMPLOYED  PHYSI-
CIANS  PARTICIPATE  IN THE IN-NETWORK   PORTION OF AN INSURER'S NETWORK,
SHALL BE DEEMED "PROVISIONALLY CREDENTIALED"  AND MAY PARTICIPATE IN THE
IN-NETWORK PORTION OF AN INSURER'S NETWORK  UPON  :  (I)  THE  INSURER'S
RECEIPT OF THE HOSPITAL AND PHYSICIAN'S COMPLETED SECTIONS OF THE INSUR-
ER'S  CREDENTIALING  APPLICATION; AND (II) THE INSURER BEING NOTIFIED IN
WRITING THAT THE HEALTH CARE  PROFESSIONAL  HAS  BEEN  GRANTED  HOSPITAL
PRIVILEGES  PURSUANT  TO  THEIR  REQUIREMENTS  OF  SECTION  TWENTY-EIGHT
HUNDRED FIVE-K OF  THE  PUBLIC  HEALTH  LAW.  HOWEVER,  A  PROVISIONALLY
CREDENTIALED  PHYSICIAN  SHALL NOT BE DESIGNATED AS AN INSURED'S PRIMARY
CARE PHYSICIAN UNTIL SUCH TIME AS THE PHYSICIAN HAS BEEN  FULLY  CREDEN-
TIALED  BY  THE  INSURER.  AN  INSURER SHALL NOT BE REQUIRED TO MAKE ANY
PAYMENTS TO THE LICENSED GENERAL HOSPITAL FOR  SERVICES  PROVIDED  BY  A
PROVISIONALLY  CREDENTIALED PHYSICIAN, UNTIL AND UNLESS THE PHYSICIAN IS
FULLY CREDENTIALED BY THE INSURER, PROVIDED, HOWEVER,  THAT  UPON  BEING
FULLY  CREDENTIALED, THE LICENSED GENERAL HOSPITAL SHALL BE PAID FOR ALL
SERVICES THAT THE  CREDENTIALED  PHYSICIAN  PROVIDED  TO  THE  INSURER'S

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD10913-01-3

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