S T A T E O F N E W Y O R K
________________________________________________________________________
5650
2015-2016 Regular Sessions
I N A S S E M B L Y
March 3, 2015
___________
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.
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD09362-01-5
A. 5650 2
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
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.