senate Bill S6281

2013-2014 Legislative Session

Requires clinical peer reviewers to be licensed, registered or certified in this state and to be in the same specialty as the health care provider being reviewed

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Archive: Last Bill Status - In Committee


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

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Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Jan 09, 2014 referred to insurance

S6281 - Details

Current Committee:
Law Section:
Insurance Law
Laws Affected:
Amd §4900, Ins L; amd §4900, Pub Health L

S6281 - Summary

Requires, for purposes of utilization review and external appeals, clinical peer reviewers to be licensed, registered or certified in this state and to be in the same specialty as the health care provider being reviewed.

S6281 - Sponsor Memo

S6281 - Bill Text download pdf

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

                                  6281

                            I N  S E N A T E

                             January 9, 2014
                               ___________

Introduced  by  Sen.  DeFRANCISCO -- 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 the definitions of "clinical peer reviewer"  for  the  purposes  of
  utilization review and external appeal

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

  Section 1.  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 PURSUANT TO ARTICLE ONE HUNDRED THIRTY-ONE
OF THE EDUCATION LAW; 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] ISSUED PURSUANT
TO TITLE EIGHT OF THE EDUCATION LAW; 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) possesses a current and valid non-restricted license  to  practice
medicine  PURSUANT  TO  ARTICLE  ONE HUNDRED THIRTY-ONE OF THE EDUCATION
LAW;
  (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 appeal;

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

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