S T A T E O F N E W Y O R K
________________________________________________________________________
1710
2015-2016 Regular Sessions
I N A S S E M B L Y
January 12, 2015
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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
because of a lack of necessary documentation, an insurer shall make
every effort to obtain such information as soon as possible.
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD00530-01-5
A. 1710 2
(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.