S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   4472
 
                        2017-2018 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 2, 2017
                                ___________
 
 Introduced  by  M.  of  A. GOTTFRIED, CAHILL, COLTON, MAGNARELLI, GALEF,
   PAULIN, LIFTON, CUSICK,  O'DONNELL,  JAFFEE,  PERRY,  JENNE,  BRONSON,
   ROSENTHAL, THIELE, BENEDETTO, TITONE, PEOPLES-STOKES, GUNTHER, WEPRIN,
   ABINANTI,  ENGLEBRIGHT,  SKOUFIS,  OTIS, AUBRY, STIRPE, CRESPO, STECK,
   HUNTER, ZEBROWSKI -- Multi-Sponsored by -- M. of  A.  ABBATE,  ARROYO,
   BRAUNSTEIN,  BUCHWALD,  CARROLL,  COOK,  CYMBROWITZ,  DINOWITZ,  FAHY,
   GLICK, HIKIND,  HOOPER,  LENTOL,  LOPEZ,  LUPARDO,  LUPINACCI,  MAGEE,
   MALLIOTAKIS, McDONALD, McDONOUGH, MONTESANO, MOYA, ORTIZ, PRETLOW, RA,
   RAIA, RICHARDSON, SEPULVEDA -- read once and referred to the Committee
   on Health
 
 AN  ACT  to amend the public health law, in relation to requirements for
   collective negotiations by health care providers with  certain  health
   benefit plans
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Statement of legislative intent. The legislature finds that
 collective negotiation by competing health care providers for the  terms
 and  conditions  of contracts with health plans can result in beneficial
 results  for  health  care  consumers.  The  legislature  further  finds
 instances  where  health plans dominate the market to such a degree that
 fair and adequate negotiations between health  care  providers  and  the
 plans are adversely affected, so that it is necessary and appropriate to
 provide  for  a  system  of  collective  action on behalf of health care
 providers. Consequently, the legislature finds it appropriate and neces-
 sary to displace competition with  regulation  of  health  plan-provider
 agreements and authorize collective negotiations on the terms and condi-
 tions  of  the  relationship  between  health care plans and health care
 providers so the imbalances between the two will not result  in  adverse
 conditions  of  health  care.  This  act  is not intended to apply to or
 affect in any respect collective bargaining  relationships  which  arise
 under applicable federal or state collective bargaining statutes.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD02214-02-7

 A. 4472                             2
 
   §  2.  This  act  shall  be known and may be cited as the "health care
 consumer and provider protection act".
   §  3.  Article  49 of the public health law is amended by adding a new
 title III to read as follows:
                                 TITLE III
                  COLLECTIVE NEGOTIATIONS BY HEALTH CARE
                     PROVIDERS WITH HEALTH CARE PLANS
 SECTION 4920. DEFINITIONS.
         4921. NON-FEE RELATED COLLECTIVE NEGOTIATION AUTHORIZED.
         4922. FEE RELATED COLLECTIVE NEGOTIATION.
         4923. COLLECTIVE NEGOTIATION REQUIREMENTS.
         4924. REQUIREMENTS FOR HEALTH CARE PROVIDERS' REPRESENTATIVE.
         4925. CERTAIN COLLECTIVE ACTION PROHIBITED.
         4926. FEES.
         4927. MONITORING OF AGREEMENTS.
         4928. CONFIDENTIALITY.
         4929. SEVERABILITY AND CONSTRUCTION.
   § 4920. DEFINITIONS. FOR PURPOSES OF THIS TITLE:
   1. "HEALTH CARE PLAN" MEANS  AN  ENTITY  (OTHER  THAN  A  HEALTH  CARE
 PROVIDER) THAT APPROVES, PROVIDES, ARRANGES FOR, OR PAYS FOR HEALTH CARE
 SERVICES, INCLUDING BUT NOT LIMITED TO:
   (A)  A  HEALTH  MAINTENANCE  ORGANIZATION LICENSED PURSUANT TO ARTICLE
 FORTY-THREE OF THE  INSURANCE  LAW  OR  CERTIFIED  PURSUANT  TO  ARTICLE
 FORTY-FOUR OF THIS CHAPTER;
   (B) ANY OTHER ORGANIZATION CERTIFIED PURSUANT TO ARTICLE FORTY-FOUR OF
 THIS CHAPTER; OR
   (C) AN INSURER OR CORPORATION SUBJECT TO THE INSURANCE LAW.
   2.  "PERSON"  MEANS  AN  INDIVIDUAL,  ASSOCIATION, CORPORATION, OR ANY
 OTHER LEGAL ENTITY.
   3. "HEALTH CARE PROVIDERS' REPRESENTATIVE" MEANS A THIRD PARTY WHO  IS
 AUTHORIZED  BY  HEALTH  CARE PROVIDERS TO NEGOTIATE ON THEIR BEHALF WITH
 HEALTH CARE PLANS OVER CONTRACTUAL TERMS AND CONDITIONS AFFECTING  THOSE
 HEALTH CARE PROVIDERS.
   4. "STRIKE" MEANS A WORK STOPPAGE IN PART OR IN WHOLE, DIRECT OR INDI-
 RECT, BY A HEALTH CARE PROVIDER OR HEALTH CARE PROVIDERS TO GAIN COMPLI-
 ANCE WITH DEMANDS MADE ON A HEALTH CARE PLAN.
   5.  "SUBSTANTIAL  MARKET  SHARE IN A BUSINESS LINE" EXISTS IF A HEALTH
 CARE PLAN'S MARKET SHARE OF A BUSINESS LINE WITHIN THE  GEOGRAPHIC  AREA
 FOR  WHICH A NEGOTIATION HAS BEEN APPROVED BY THE COMMISSIONER, ALONE OR
 IN COMBINATION WITH THE MARKET SHARES OF AFFILIATES, EXCEEDS EITHER  TEN
 PERCENT  OF  THE  TOTAL NUMBER OF COVERED LIVES IN THAT SERVICE AREA FOR
 SUCH BUSINESS LINE OR TWENTY-FIVE THOUSAND LIVES, OR IF THE COMMISSIONER
 DETERMINES THE MARKET SHARE OF THE INSURER  IN  THE  RELEVANT  INSURANCE
 PRODUCT AND GEOGRAPHIC MARKETS FOR THE SERVICES OF THE PROVIDERS SEEKING
 TO  COLLECTIVELY  NEGOTIATE  SIGNIFICANTLY  EXCEEDS  THE  COUNTERVAILING
 MARKET SHARE OF THE PROVIDERS ACTING INDIVIDUALLY.
   6. "HEALTH CARE PROVIDER" MEANS A PERSON WHO IS  LICENSED,  CERTIFIED,
 REGISTERED  OR  AUTHORIZED  PURSUANT TO TITLE EIGHT OF THE EDUCATION LAW
 AND WHO PRACTICES THAT PROFESSION AS A HEALTH CARE PROVIDER AS AN  INDE-
 PENDENT  CONTRACTOR  AND/OR  WHO  IS  AN OWNER, OFFICER, SHAREHOLDER, OR
 PROPRIETOR OF A HEALTH CARE PROVIDER,  OR  AN  ENTITY  THAT  EMPLOYS  OR
 UTILIZES  HEALTH CARE PROVIDERS TO PROVIDE HEALTH CARE SERVICES, INCLUD-
 ING BUT NOT LIMITED TO A HOSPITAL LICENSED UNDER ARTICLE TWENTY-EIGHT OF
 THIS CHAPTER OR AN ACCOUNTABLE CARE ORGANIZATION UNDER  ARTICLE  TWENTY-
 NINE-E  OF  THIS CHAPTER; OR AN ENTITY AUTHORIZED UNDER ARTICLES THIRTY-
 SIX OR FORTY OF THIS CHAPTER; OR A FISCAL INTERMEDIARY OPERATING  PURSU-

 A. 4472                             3
 
 ANT TO SECTION THREE HUNDRED SIXTY-FIVE-F OF THE SOCIAL SERVICES LAW.  A
 HEALTH  CARE  PROVIDER  UNDER TITLE EIGHT OF THE EDUCATION LAW WHO PRAC-
 TICES AS AN EMPLOYEE OF A HEALTH CARE PROVIDER SHALL  NOT  BE  DEEMED  A
 HEALTH CARE PROVIDER FOR PURPOSES OF THIS TITLE.
   §  4921.  NON-FEE RELATED COLLECTIVE NEGOTIATION AUTHORIZED. 1. HEALTH
 CARE PROVIDERS PRACTICING WITHIN THE GEOGRAPHIC AREA FOR WHICH A NEGOTI-
 ATION HAS BEEN APPROVED BY THE COMMISSIONER MAY MEET AND COMMUNICATE FOR
 THE PURPOSE OF COLLECTIVELY NEGOTIATING THE FOLLOWING TERMS  AND  CONDI-
 TIONS OF PROVIDER CONTRACTS WITH THE HEALTH CARE PLAN:
   (A)  THE DETAILS OF THE UTILIZATION REVIEW PLAN AS DEFINED PURSUANT TO
 SUBDIVISION TEN OF  SECTION  FORTY-NINE  HUNDRED  OF  THIS  ARTICLE  AND
 SUBSECTION  (J)  OF  SECTION FOUR THOUSAND NINE HUNDRED OF THE INSURANCE
 LAW;
   (B) COVERAGE  PROVISIONS;  HEALTH  CARE  BENEFITS;  BENEFIT  MAXIMUMS,
 INCLUDING BENEFIT LIMITATIONS; AND EXCLUSIONS OF COVERAGE;
   (C) THE DEFINITION OF MEDICAL NECESSITY;
   (D)  THE  CLINICAL  PRACTICE GUIDELINES USED TO MAKE MEDICAL NECESSITY
 AND UTILIZATION REVIEW DETERMINATIONS;
   (E) PREVENTIVE CARE AND OTHER MEDICAL MANAGEMENT PRACTICES;
   (F) DRUG FORMULARIES AND  STANDARDS  AND  PROCEDURES  FOR  PRESCRIBING
 OFF-FORMULARY DRUGS;
   (G) RESPECTIVE PHYSICIAN LIABILITY FOR THE TREATMENT OR LACK OF TREAT-
 MENT OF COVERED PERSONS;
   (H)  THE  DETAILS  OF HEALTH CARE PLAN RISK TRANSFER ARRANGEMENTS WITH
 PROVIDERS;
   (I) PLAN ADMINISTRATIVE PROCEDURES, INCLUDING METHODS  AND  TIMING  OF
 HEALTH CARE PROVIDER PAYMENT FOR SERVICES;
   (J)  PROCEDURES  TO BE UTILIZED TO RESOLVE DISPUTES BETWEEN THE HEALTH
 CARE PLAN AND HEALTH CARE PROVIDERS;
   (K) PATIENT REFERRAL PROCEDURES INCLUDING, BUT NOT LIMITED  TO,  THOSE
 APPLICABLE TO OUT-OF-NETWORK REFERRALS;
   (L) THE FORMULATION AND APPLICATION OF HEALTH CARE PROVIDER REIMBURSE-
 MENT PROCEDURES;
   (M) QUALITY ASSURANCE PROGRAMS;
   (N)  THE  PROCESS  FOR  RENDERING  UTILIZATION  REVIEW  DETERMINATIONS
 INCLUDING: ESTABLISHMENT OF A PROCESS FOR RENDERING  UTILIZATION  REVIEW
 DETERMINATIONS WHICH SHALL, AT A MINIMUM, INCLUDE: WRITTEN PROCEDURES TO
 ASSURE  THAT UTILIZATION REVIEWS AND DETERMINATIONS ARE CONDUCTED WITHIN
 THE TIMEFRAMES ESTABLISHED IN THIS  ARTICLE;  PROCEDURES  TO  NOTIFY  AN
 ENROLLEE,  AN  ENROLLEE'S  DESIGNEE  AND/OR  AN  ENROLLEE'S  HEALTH CARE
 PROVIDER OF ADVERSE DETERMINATIONS; AND PROCEDURES FOR APPEAL OF ADVERSE
 DETERMINATIONS, INCLUDING THE  ESTABLISHMENT  OF  AN  EXPEDITED  APPEALS
 PROCESS  FOR DENIALS OF CONTINUED INPATIENT CARE OR WHERE THERE IS IMMI-
 NENT OR SERIOUS THREAT TO THE HEALTH OF THE ENROLLEE; AND
   (O) HEALTH CARE PROVIDER SELECTION AND TERMINATION  CRITERIA  USED  BY
 THE HEALTH CARE PLAN.
   2. NOTHING IN THIS SECTION SHALL BE CONSTRUED TO ALLOW OR AUTHORIZE AN
 ALTERATION  OF  THE TERMS OF THE INTERNAL AND EXTERNAL REVIEW PROCEDURES
 SET FORTH IN LAW.
   3. NOTHING IN THIS SECTION SHALL BE CONSTRUED TO ALLOW A STRIKE  OF  A
 HEALTH  CARE  PLAN  BY  HEALTH  CARE PROVIDERS OR PLANS AS OTHERWISE SET
 FORTH IN THE LAWS OF THIS STATE.
   4. NOTHING IN THIS SECTION SHALL BE CONSTRUED TO  ALLOW  OR  AUTHORIZE
 TERMS OR CONDITIONS WHICH WOULD IMPEDE THE ABILITY OF A HEALTH CARE PLAN
 TO  OBTAIN OR RETAIN ACCREDITATION BY THE NATIONAL COMMITTEE FOR QUALITY
 ASSURANCE OR A SIMILAR BODY.

 A. 4472                             4
 
   § 4922. FEE RELATED COLLECTIVE NEGOTIATION. 1. IF THE HEALTH CARE PLAN
 HAS SUBSTANTIAL MARKET SHARE IN A BUSINESS LINE IN ANY  GEOGRAPHIC  AREA
 FOR  WHICH  A  NEGOTIATION HAS BEEN APPROVED BY THE COMMISSIONER, HEALTH
 CARE PROVIDERS PRACTICING WITHIN THAT GEOGRAPHIC AREA  MAY  COLLECTIVELY
 NEGOTIATE  THE  FOLLOWING TERMS AND CONDITIONS RELATING TO THAT BUSINESS
 LINE WITH THE HEALTH CARE PLAN:
   (A) THE FEES ASSESSED BY THE HEALTH CARE PLAN FOR SERVICES,  INCLUDING
 FEES ESTABLISHED THROUGH THE APPLICATION OF REIMBURSEMENT PROCEDURES;
   (B)  THE  CONVERSION  FACTORS  USED  BY  THE  HEALTH  CARE  PLAN  IN A
 RESOURCE-BASED RELATIVE VALUE SCALE REIMBURSEMENT METHODOLOGY  OR  OTHER
 SIMILAR  METHODOLOGY; PROVIDED THE SAME ARE NOT OTHERWISE ESTABLISHED BY
 STATE OR FEDERAL LAW OR REGULATION;
   (C) THE AMOUNT OF ANY DISCOUNT GRANTED BY THE HEALTH CARE PLAN ON  THE
 FEE OF HEALTH CARE SERVICES TO BE RENDERED BY HEALTH CARE PROVIDERS;
   (D)  THE  DOLLAR  AMOUNT  OF  CAPITATION  OR  FIXED PAYMENT FOR HEALTH
 SERVICES RENDERED BY HEALTH CARE PROVIDERS TO HEALTH  CARE  PLAN  ENROL-
 LEES;
   (E)  THE  PROCEDURE CODE OR OTHER DESCRIPTION OF A HEALTH CARE SERVICE
 COVERED BY A PAYMENT AND  THE  APPROPRIATE  GROUPING  OF  THE  PROCEDURE
 CODES; OR
   (F) THE AMOUNT OF ANY OTHER COMPONENT OF THE REIMBURSEMENT METHODOLOGY
 FOR A HEALTH CARE SERVICE.
   2.  NOTHING  HEREIN  SHALL BE DEEMED TO AFFECT OR LIMIT THE RIGHT OF A
 HEALTH CARE PROVIDER OR GROUP OF HEALTH CARE PROVIDERS  TO  COLLECTIVELY
 PETITION A GOVERNMENT ENTITY FOR A CHANGE IN A LAW, RULE, OR REGULATION.
   § 4923. COLLECTIVE NEGOTIATION REQUIREMENTS. 1. COLLECTIVE NEGOTIATION
 RIGHTS GRANTED BY THIS TITLE MUST CONFORM TO THE FOLLOWING REQUIREMENTS:
   (A)  HEALTH  CARE  PROVIDERS  MAY  COMMUNICATE  WITH OTHER HEALTH CARE
 PROVIDERS REGARDING THE CONTRACTUAL TERMS AND CONDITIONS TO  BE  NEGOTI-
 ATED WITH A HEALTH CARE PLAN;
   (B)  HEALTH CARE PROVIDERS MAY COMMUNICATE WITH HEALTH CARE PROVIDERS'
 REPRESENTATIVES;
   (C) A HEALTH CARE PROVIDERS' REPRESENTATIVE IS THE ONLY PARTY  AUTHOR-
 IZED  TO  NEGOTIATE  WITH HEALTH CARE PLANS ON BEHALF OF THE HEALTH CARE
 PROVIDERS AS A GROUP;
   (D) A HEALTH CARE PROVIDER CAN BE BOUND BY THE  TERMS  AND  CONDITIONS
 NEGOTIATED BY THE HEALTH CARE PROVIDERS' REPRESENTATIVES; AND
   (E)  IN  COMMUNICATING  OR NEGOTIATING WITH THE HEALTH CARE PROVIDERS'
 REPRESENTATIVE, A HEALTH CARE PLAN IS ENTITLED TO CONTRACT WITH OR OFFER
 DIFFERENT CONTRACT TERMS AND CONDITIONS TO INDIVIDUAL  COMPETING  HEALTH
 CARE PROVIDERS.
   2. A HEALTH CARE PROVIDERS' REPRESENTATIVE MAY NOT REPRESENT MORE THAN
 THIRTY PERCENT OF THE MARKET OF HEALTH CARE PROVIDERS OR OF A PARTICULAR
 HEALTH CARE PROVIDER TYPE OR SPECIALTY PRACTICING IN THE GEOGRAPHIC AREA
 FOR  WHICH  A  NEGOTIATION  HAS BEEN APPROVED BY THE COMMISSIONER IF THE
 HEALTH CARE PLAN COVERS LESS THAN FIVE PERCENT OF THE ACTUAL  NUMBER  OF
 COVERED  LIVES OF THE HEALTH CARE PLAN IN THE AREA, AS DETERMINED BY THE
 DEPARTMENT.
   3. NOTHING IN THIS SECTION SHALL BE CONSTRUED TO  PROHIBIT  COLLECTIVE
 ACTION  ON  THE  PART  OF  ANY HEALTH CARE PROVIDER WHO IS A MEMBER OF A
 COLLECTIVE BARGAINING UNIT RECOGNIZED PURSUANT  TO  THE  NATIONAL  LABOR
 RELATIONS ACT.
   §  4924.  REQUIREMENTS  FOR  HEALTH CARE PROVIDERS' REPRESENTATIVE. 1.
 BEFORE ENGAGING IN COLLECTIVE NEGOTIATIONS WITH A HEALTH  CARE  PLAN  ON
 BEHALF OF HEALTH CARE PROVIDERS, A HEALTH CARE PROVIDERS' REPRESENTATIVE
 SHALL  FILE  WITH  THE  COMMISSIONER,  IN  THE  MANNER PRESCRIBED BY THE

 A. 4472                             5
 
 COMMISSIONER, INFORMATION IDENTIFYING THE REPRESENTATIVE, THE  REPRESEN-
 TATIVE'S  PLAN  OF  OPERATION,  AND  THE  REPRESENTATIVE'S PROCEDURES TO
 ENSURE COMPLIANCE WITH THIS TITLE.
   2.  BEFORE  ENGAGING  IN  THE COLLECTIVE NEGOTIATIONS, THE HEALTH CARE
 PROVIDERS' REPRESENTATIVE SHALL ALSO SUBMIT TO THE COMMISSIONER FOR  THE
 COMMISSIONER'S APPROVAL A REPORT IDENTIFYING THE PROPOSED SUBJECT MATTER
 OF  THE  NEGOTIATIONS  OR  DISCUSSIONS WITH THE HEALTH CARE PLAN AND THE
 EFFICIENCIES OR BENEFITS EXPECTED TO BE  ACHIEVED  THROUGH  THE  NEGOTI-
 ATIONS  FOR  BOTH  THE  PROVIDERS  AND CONSUMERS OF HEALTH SERVICES. THE
 COMMISSIONER SHALL NOT  APPROVE  THE  REPORT  IF  THE  COMMISSIONER,  IN
 CONSULTATION  WITH  THE  SUPERINTENDENT OF FINANCIAL SERVICES DETERMINES
 THAT THE PROPOSED NEGOTIATIONS WOULD EXCEED THE AUTHORITY GRANTED  UNDER
 THIS TITLE.
   3.  THE  REPRESENTATIVE SHALL SUPPLEMENT THE INFORMATION IN THE REPORT
 ON A REGULAR BASIS OR AS NEW INFORMATION BECOMES  AVAILABLE,  INDICATING
 THAT  THE  SUBJECT  MATTER OF THE NEGOTIATIONS WITH THE HEALTH CARE PLAN
 HAS CHANGED OR WILL CHANGE. IN NO EVENT SHALL THE REPORT  BE  LESS  THAN
 EVERY THIRTY DAYS.
   4. WITH THE ADVICE OF THE SUPERINTENDENT OF FINANCIAL SERVICES AND THE
 ATTORNEY  GENERAL,  THE  COMMISSIONER  SHALL  APPROVE  OR DISAPPROVE THE
 REPORT NOT LATER THAN THE TWENTIETH DAY AFTER  THE  DATE  ON  WHICH  THE
 REPORT  IS FILED. IF DISAPPROVED, THE COMMISSIONER SHALL FURNISH A WRIT-
 TEN EXPLANATION OF ANY DEFICIENCIES, ALONG WITH A STATEMENT OF  SPECIFIC
 PROPOSALS FOR REMEDIAL MEASURES TO CURE THE DEFICIENCIES. IF THE COMMIS-
 SIONER  DOES  NOT  SO  ACT  WITHIN  THE TWENTY DAYS, THE REPORT SHALL BE
 DEEMED APPROVED.
   5. A PERSON WHO ACTS AS A HEALTH CARE PROVIDERS' REPRESENTATIVE  WITH-
 OUT  THE APPROVAL OF THE COMMISSIONER UNDER THIS SECTION SHALL BE DEEMED
 TO BE ACTING OUTSIDE THE AUTHORITY GRANTED UNDER THIS TITLE.
   6. BEFORE REPORTING THE RESULTS OF NEGOTIATIONS  WITH  A  HEALTH  CARE
 PLAN OR PROVIDING TO THE AFFECTED HEALTH CARE PROVIDERS AN EVALUATION OF
 ANY  OFFER MADE BY A HEALTH CARE PLAN, THE HEALTH CARE PROVIDERS' REPRE-
 SENTATIVE SHALL FURNISH FOR APPROVAL BY THE COMMISSIONER, BEFORE DISSEM-
 INATION TO THE HEALTH CARE PROVIDERS, A COPY OF ALL COMMUNICATIONS TO BE
 MADE TO THE HEALTH CARE PROVIDERS RELATED TO NEGOTIATIONS,  DISCUSSIONS,
 AND OFFERS MADE BY THE HEALTH CARE PLAN.
   7.  A  HEALTH  CARE PROVIDERS' REPRESENTATIVE  SHALL REPORT THE END OF
 NEGOTIATIONS TO THE COMMISSIONER NOT LATER THAN THE FOURTEENTH DAY AFTER
 THE DATE OF A HEALTH CARE PLAN DECISION DECLINING NEGOTIATION, CANCELING
 NEGOTIATIONS, OR FAILING TO RESPOND TO A REQUEST FOR  NEGOTIATION.    IN
 SUCH  INSTANCES,  A  HEALTH  CARE  PROVIDERS' REPRESENTATIVE MAY REQUEST
 INTERVENTION FROM THE COMMISSIONER TO REQUIRE THE HEALTH  CARE  PLAN  TO
 PARTICIPATE  IN  THE  NEGOTIATION  PURSUANT TO SUBDIVISION EIGHT OF THIS
 SECTION.
   8. (A) IN THE EVENT THE COMMISSIONER DETERMINES THAT AN IMPASSE EXISTS
 IN THE NEGOTIATIONS, OR IN THE EVENT A  HEALTH  CARE  PLAN  DECLINES  TO
 NEGOTIATE,  CANCELS  NEGOTIATIONS  OR  FAILS TO RESPOND TO A REQUEST FOR
 NEGOTIATION, THE COMMISSIONER SHALL RENDER ASSISTANCE AS FOLLOWS:
   (1) TO ASSIST THE PARTIES TO EFFECT  A  VOLUNTARY  RESOLUTION  OF  THE
 NEGOTIATIONS,  THE  COMMISSIONER SHALL APPOINT A MEDIATOR FROM A LIST OF
 QUALIFIED PERSONS MAINTAINED BY THE COMMISSIONER.  IF  THE  MEDIATOR  IS
 SUCCESSFUL  IN  RESOLVING  THE  IMPASSE, THEN THE HEALTH CARE PROVIDERS'
 REPRESENTATIVE SHALL PROCEED AS SET FORTH IN THIS ARTICLE;
   (2) IF AN IMPASSE CONTINUES, THE COMMISSIONER SHALL  APPOINT  A  FACT-
 FINDING  BOARD  OF  NOT MORE THAN THREE MEMBERS FROM A LIST OF QUALIFIED
 PERSONS MAINTAINED BY THE COMMISSIONER, WHICH FACT-FINDING  BOARD  SHALL

 A. 4472                             6
 
 HAVE,  IN ADDITION TO THE POWERS DELEGATED TO IT BY THE BOARD, THE POWER
 TO MAKE RECOMMENDATIONS FOR THE RESOLUTION OF THE DISPUTE;
   (B) THE FACT-FINDING BOARD, ACTING BY A MAJORITY OF ITS MEMBERS, SHALL
 TRANSMIT  ITS FINDINGS OF FACT AND RECOMMENDATIONS FOR RESOLUTION OF THE
 DISPUTE TO THE COMMISSIONER, AND MAY THEREAFTER ASSIST  THE  PARTIES  TO
 EFFECT  A  VOLUNTARY  RESOLUTION  OF THE DISPUTE. THE FACT-FINDING BOARD
 SHALL ALSO SHARE ITS FINDINGS  OF  FACT  AND  RECOMMENDATIONS  WITH  THE
 HEALTH CARE PROVIDERS' REPRESENTATIVE AND THE HEALTH CARE PLAN. IF WITH-
 IN  TWENTY  DAYS AFTER THE SUBMISSION OF THE FINDINGS OF FACT AND RECOM-
 MENDATIONS, THE IMPASSE CONTINUES, THE COMMISSIONER SHALL ORDER A RESOL-
 UTION  TO  THE  NEGOTIATIONS  BASED  UPON  THE  FINDINGS  OF  FACT   AND
 RECOMMENDATIONS SUBMITTED BY THE FACT-FINDING BOARD.
   9.  ANY  PROPOSED AGREEMENT BETWEEN HEALTH CARE PROVIDERS AND A HEALTH
 CARE PLAN NEGOTIATED PURSUANT TO THIS TITLE SHALL BE  SUBMITTED  TO  THE
 COMMISSIONER  FOR  FINAL  APPROVAL.  THE  COMMISSIONER  SHALL APPROVE OR
 DISAPPROVE THE AGREEMENT WITHIN SIXTY DAYS OF SUCH SUBMISSION.
   10. THE COMMISSIONER MAY COLLECT INFORMATION  FROM  OTHER  PERSONS  TO
 ASSIST  IN  EVALUATING  THE  IMPACT  OF  THE PROPOSED ARRANGEMENT ON THE
 HEALTH CARE MARKETPLACE. THE COMMISSIONER SHALL COLLECT INFORMATION FROM
 HEALTH PLAN COMPANIES AND HEALTH CARE PROVIDERS OPERATING  IN  THE  SAME
 GEOGRAPHIC AREA.
   §  4925.  CERTAIN  COLLECTIVE  ACTION PROHIBITED. 1. THIS TITLE IS NOT
 INTENDED TO AUTHORIZE COMPETING HEALTH CARE PROVIDERS TO ACT IN  CONCERT
 IN  RESPONSE  TO A REPORT ISSUED BY THE HEALTH CARE PROVIDERS' REPRESEN-
 TATIVE RELATED TO THE REPRESENTATIVE'S DISCUSSIONS OR NEGOTIATIONS  WITH
 HEALTH CARE PLANS.
   2. NO HEALTH CARE PROVIDERS' REPRESENTATIVE SHALL NEGOTIATE ANY AGREE-
 MENT  THAT  EXCLUDES,  LIMITS  THE PARTICIPATION OR REIMBURSEMENT OF, OR
 OTHERWISE LIMITS THE SCOPE OF SERVICES TO BE PROVIDED BY ANY HEALTH CARE
 PROVIDER OR GROUP OF HEALTH CARE PROVIDERS WITH RESPECT TO THE  PERFORM-
 ANCE  OF  SERVICES  THAT  ARE WITHIN THE HEALTH CARE PROVIDER'S SCOPE OF
 PRACTICE, LICENSE, REGISTRATION, OR CERTIFICATE.
   § 4926. FEES. EACH PERSON WHO ACTS AS THE REPRESENTATIVE OR  NEGOTIAT-
 ING PARTIES UNDER THIS TITLE SHALL PAY TO THE DEPARTMENT A FEE TO ACT AS
 A  REPRESENTATIVE.  THE COMMISSIONER, BY RULE, SHALL SET FEES IN AMOUNTS
 DEEMED REASONABLE AND NECESSARY TO  COVER  THE  COSTS  INCURRED  BY  THE
 DEPARTMENT  IN  ADMINISTERING  THIS  TITLE. ANY FEE COLLECTED UNDER THIS
 SECTION SHALL BE DEPOSITED IN THE STATE TREASURY TO THE  CREDIT  OF  THE
 GENERAL FUND/STATE OPERATIONS - 003 FOR THE NEW YORK STATE DEPARTMENT OF
 HEALTH FUND.
   §  4927.  MONITORING  OF  AGREEMENTS.  THE COMMISSIONER SHALL ACTIVELY
 MONITOR AGREEMENTS APPROVED UNDER THIS TITLE TO ENSURE THAT  THE  AGREE-
 MENT  REMAINS  IN  COMPLIANCE  WITH  THE  CONDITIONS  OF  APPROVAL. UPON
 REQUEST, A HEALTH CARE PLAN OR HEALTH CARE PROVIDER SHALL PROVIDE INFOR-
 MATION REGARDING COMPLIANCE. THE COMMISSIONER  MAY  REVOKE  AN  APPROVAL
 UPON  A FINDING THAT THE AGREEMENT IS NOT IN SUBSTANTIAL COMPLIANCE WITH
 THE TERMS OF THE APPLICATION OR THE CONDITIONS OF APPROVAL.
   § 4928. CONFIDENTIALITY. ALL REPORTS AND OTHER INFORMATION REQUIRED TO
 BE REPORTED TO THE DEPARTMENT OF LAW UNDER THIS TITLE INCLUDING INFORMA-
 TION OBTAINED BY THE COMMISSIONER PURSUANT TO SUBDIVISION TEN OF SECTION
 FORTY-NINE HUNDRED TWENTY-FOUR OF THIS TITLE SHALL  NOT  BE  SUBJECT  TO
 DISCLOSURE UNDER ARTICLE SIX OF THE PUBLIC OFFICERS LAW OR ARTICLE THIR-
 TY-ONE OF THE CIVIL PRACTICE LAW AND RULES.
   §  4929.  SEVERABILITY  AND CONSTRUCTION. THE PROVISIONS OF THIS TITLE
 SHALL BE SEVERABLE, AND IF ANY COURT OF COMPETENT JURISDICTION  DECLARES
 ANY  PHRASE,  CLAUSE, SENTENCE OR PROVISION OF THIS TITLE TO BE INVALID,

 A. 4472                             7

 OR ITS APPLICABILITY TO ANY GOVERNMENT, AGENCY, PERSON  OR  CIRCUMSTANCE
 IS DECLARED INVALID, THE REMAINDER OF THIS TITLE AND ITS RELEVANT APPLI-
 CABILITY  SHALL  NOT  BE AFFECTED. THE PROVISIONS OF THIS TITLE SHALL BE
 LIBERALLY CONSTRUED TO GIVE EFFECT TO THE PURPOSES THEREOF.
   § 4. This act shall take effect on the one hundred twentieth day after
 it  shall have become a law; provided that the commissioner of health is
 authorized to promulgate any and all rules and regulations and take  any
 other  measures necessary to implement this act on its effective date on
 or before such date.