NY State Senate Bill 2017-S1331

Archive: Last Bill Status - In Senate Committee Insurance Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Date of Action	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 03, 2018	referred to insurance
Jan 09, 2017	referred to insurance

co-Sponsors

2017-S1331 (ACTIVE) - Details

See Assembly Version of this Bill:: A1529
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §4803, Ins L; amd §4406-d, Pub Health L
Versions Introduced in Other Legislative Sessions:: 2013-2014: S5155, A7569
2015-2016: S629, A6168

2017-S1331 (ACTIVE) - Summary

Relates to the provisional credentialing of physicians.

2017-S1331 (ACTIVE) - Sponsor Memo

                                 BILL NUMBER:  S1331

 TITLE OF BILL :  An act to amend the insurance law and the public
health law, in relation to provider credentialing

 PURPOSE :

The purpose of this bill is to permit newly licensed providers,
providers moving to New York State, or a physician who has changed
their corporate relationship such that it results in the issuance of a
new tax identification number under which their services are billed
for, who are employed by licensed Article 28 facilities and have
applied to be credentialed as part of a health plan's provider network
to be considered provisionally credentialed from the date the health
plan receives the hospital and physicians completed sections of the
plan's credentialing application and the plan is notified in writing
that the physician has been granted hospital privileges.

 SUMMARY OF PROVISIONS :

Section 1 of the bill amends subsection (a) of Section 4803 of the
insurance law by adding a new paragraph (3) that provides that newly
licensed physicians, physicians that have recently relocated to the
state or a physician who has changed their corporate relations hip
such that it results in the issuance of a new tax identification
number under which their services are billed for, who are employed by

a licensed Article 28 facility whose other employed health care
professionals participate in the in-network portion of a health plan's
network shall be considered provisionally credentialed from the date
the health insurer receives the hospital and physician's completed
sections of the insurer's credentialing application and the insurer is
notified in writing that the physician has been granted hospital
privileges.

Section 2 amends Subsection 1 of Section 446-d of the public health
law by adding a new paragraph (c) that provides that newly licensed
physicians, physicians that have recently relocated to the state or a
physician who has changed their corporate relationship such that it
results in the issuance of a new tax identification number under which
their services are billed for, who are employed by a licensed Article
28 * facility whose other employed health care professionals
participate in the in-network portion of a health plan's network shall
be considered provisionally credentialed from the date the health plan
receives the hospital and physician's completed sections of the plan's
credentialing application and the plan is notified in writing that the
physician has been granted hospital privileges.

Section 3 is the effective date.

 EXISTING LAW :

The latest of the managed care reform laws (Chapter 237 of the Laws of
2009) provided that newly licensed health care professionals or health
care professionals that recently relocated to New York State who
joined a group practice of health care professionals and have applied
to be credentialed as part of the in-network of a health plan's
network are considered provisionally credentialed if their application
is not approved or denied with 90 days from the date of application.

 JUSTIFICATION :

The model of care delivery is gradually shifting from a physician
private practice model to a model of hospital or health system
employed physicians. In fact, a leading physician recruiting firms
(Merritt Hawkins) has predicted that by 2015, over 75% of newly hired
physicians will be hospital employees. In order to recruit and retain
physicians, upstate hospitals in a market of increasing physician
shortage have been forced to be at the forefront of this shifting
model of care. However, faced with increasingly constrained revenue
from Medicare and Medicaid cuts and commercial health plans,
hospitals, who most often lose money on physicians services component
of care even with full payment, cannot carry afford to carry a
physician on salary for 90 days without reimbursement for their
services nor based on the physician shortage can they afford to be
without the services of these physicians.

Hospitals as licensed and regulated Article 28 facilities are
statutorily required to credential any provider before extending
admitting privileges or allowing the professional to provide care
within the facility. According to both hospitals and health plan
administrators it is almost unheard of for a hospital itself to employ
any physician who would be unsuitable for health plan credentialing.

All too often credentialing decisions and notification are delayed by
simple administrative processes such has the delayed paperwork or the
next scheduled meeting of the health plan's credentialing committee,
The legislation would allow the hospitals to maximize the use of
scarce health manpower and to be reimbursed for the services their
employed physicians provide. The bill also provide for strict
financial controls whereby the payments for all services provided to
the health plans' enrollees are held and only after the health plan
fully credentials the provider, are the payments for services rendered
transmitted. Should a health plan, in rare cases, and for valid
reasons elect not to credential a hospital employed physician then the
payments to the hospital by the health plan are limited to the out of
network payment, should the enrollee have coverage for out-of-network
care.

 LEGISLATIVE HISTORY :

05/13/13 REFERRED TO INSURANCE
01/08/14 REFERRED TO INSURANCE
01/07/15 REFERRED TO INSURANCE
06/07/16 PASSED SENATE

 FISCAL IMPLICATIONS :

None

 LOCAL FISCAL IMPLICATIONS :

None

 EFFECTIVE DATE :
This bill is effective ninety days after which it shall have become
law, and applies to applications submitted after that date, and shall
not apply submitted prior to such date if such application is
resubmitted in substantially similar form on or after the date on
which this act shall have become law.

2017-S1331 (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1331
 
                        2017-2018 Regular Sessions
 
                             I N  S E N A T E
 
                              January 9, 2017
                                ___________
 
 Introduced  by  Sens.  VALESKY,  DeFRANCISCO,  HANNON  -- 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 PHYSICIANS
 PARTICIPATE IN THE IN-NETWORK  PORTION OF AN INSURER'S NETWORK, SHALL BE
 DEEMED "PROVISIONALLY CREDENTIALED"  AND MAY PARTICIPATE IN THE  IN-NET-
 WORK PORTION OF AN INSURER'S NETWORK UPON : (I) THE INSURER'S RECEIPT OF
 THE HOSPITAL AND PHYSICIAN'S COMPLETED SECTIONS OF THE INSURER'S CREDEN-
 TIALING APPLICATION; AND (II) THE INSURER BEING NOTIFIED IN WRITING THAT
 THE HEALTH CARE PROFESSIONAL HAS BEEN GRANTED HOSPITAL PRIVILEGES PURSU-
 ANT  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 CREDENTIALED 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  PHYSI-
 CIAN, UNTIL AND UNLESS THE PHYSICIAN IS FULLY CREDENTIALED BY THE INSUR-
 ER,  PROVIDED, HOWEVER, THAT UPON BEING FULLY CREDENTIALED, THE LICENSED
 GENERAL HOSPITAL SHALL BE PAID FOR ALL SERVICES  THAT  THE  CREDENTIALED
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD02441-02-7

 S. 1331                             2
 
 PHYSICIAN PROVIDED TO THE INSURER'S INSUREDS FROM THE DATE THE PHYSICIAN
 FULLY  MET THE REQUIREMENTS TO BE PROVISIONALLY CREDENTIALED PURSUANT TO
 THIS PARAGRAPH. SHOULD THE  APPLICATION  ULTIMATELY  BE  DENIED  BY  THE
 INSURER, THE INSURER SHALL NOT BE LIABLE FOR ANY PAYMENT TO THE LICENSED
 GENERAL  HOSPITAL FOR THE SERVICES PROVIDED BY THE PROVISIONALLY CREDEN-
 TIALED HEALTH CARE PROFESSIONAL THAT EXCEED ANY OUT-OF-NETWORK  BENEFITS
 PAYABLE  UNDER THE INSURED'S CONTRACT WITH THE INSURER; AND THE LICENSED
 GENERAL HOSPITAL SHALL NOT PURSUE REIMBURSEMENT FORM THE INSURED, EXCEPT
 TO COLLECT THE COPAYMENT OR COINSURANCE THAT OTHERWISE WOULD  HAVE  BEEN
 PAYABLE  HAD  THE  INSURED  RECEIVED SERVICES FROM A HEALTH CARE PROFES-
 SIONAL PARTICIPATING IN THE IN-NETWORK PORTION OF AN INSURER'S NETWORK.
   § 2. Subdivision 1 of section 4406-d  of  the  public  health  law  is
 amended by adding a new paragraph (c) to read as follows:
   (C) 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  THIS CHAPTER, AND WHOSE OTHER EMPLOYED PHYSICIANS PARTICIPATE
 IN THE IN-NETWORK PORTION OF A HEALTH  CARE  PLAN'S  NETWORK,  SHALL  BE
 DEEMED  "PROVISIONALLY CREDENTIALLED" AND MAY PARTICIPATE IN THE IN-NET-
 WORK PORTION OF A HEALTH  CARE  PLAN'S  NETWORK  UPON:  (I)  THE  PLAN'S
 RECEIPT  OF THE HOSPITAL AND PHYSICIAN'S COMPLETED SECTION OF THE PLAN'S
 CREDENTIALING APPLICATION; AND (II) THE HEALTH CARE PLAN BEING  NOTIFIED
 IN  WRITING  THAT THE HEALTH CARE PROFESSIONAL HAS BEEN GRANTED HOSPITAL
 PRIVILEGE PURSUANT TO THE REQUIREMENTS OF SECTION  TWENTY-EIGHT  HUNDRED
 FIVE-K  OF THIS CHAPTER. HOWEVER, A PROVISIONALLY CREDENTIALED PHYSICIAN
 SHALL NOT BE DESIGNATED AS AN ENROLLEE'S PRIMARY  CARE  PHYSICIAN  UNTIL
 SUCH  TIME  AS  THE  PHYSICIAN HAS BEEN FULLY CREDENTIALED BY THE HEALTH
 CARE PLAN. A HEALTH CARE PLAN SHALL NOT BE REQUIRED TO MAKE ANY PAYMENTS
 TO THE LICENSED GENERAL HOSPITAL  FOR  SERVICED  PROVIDED  BY  A  PROVI-
 SIONALLY CREDENTIALED PHYSICIAN, UNTIL AND UNLESS THE PHYSICIAN IS FULLY
 CREDENTIALED  BY  THE HEALTH CARE PLAN, PROVIDED HOWEVER THAT UPON BEING
 FULLY CREDENTIALED, THE LICENSED GENERAL HOSPITAL SHALL BE PAID FOR  ALL
 SERVICES  THAT  THE CREDENTIALED PHYSICIAN PROVIDED TO THE HEALTH PLAN'S
 ENROLLEES FROM THE DATE THE PHYSICIAN FULLY MET THE REQUIREMENTS  TO  BE
 PROVISIONALLY CREDENTIALED PURSUANT TO THIS PARAGRAPH. SHOULD THE APPLI-
 CATION  ULTIMATELY  BE  DENIED  BY THE HEALTH CARE PLAN, THE HEALTH CARE
 PLAN SHALL NOT BE LIABLE FOR ANY PAYMENT TO THE LICENSED GENERAL  HOSPI-
 TAL  FOR  THE SERVICES PROVIDED BY THE PROVISIONALLY CREDENTIALED HEALTH
 CARE PROFESSIONAL THAT EXCEED ANY OUT-OF-NETWORK BENEFITS PAYABLE  UNDER
 THE  ENROLLEE'S  CONTRACT  WITH  THE  HEALTH  CARE PLAN AND THE LICENSED
 GENERAL HOSPITAL SHALL  NOT  PURSUE  REIMBURSEMENT  FORM  THE  ENROLLEE,
 EXCEPT TO COLLECT THE COPAYMENT OR COINSURANCE THAT OTHERWISE WOULD HAVE
 BEEN  PAYABLE  HAD  THE  ENROLLEE  RECEIVED  SERVICES FROM A HEALTH CARE
 PROFESSIONAL PARTICIPATING IN THE IN-NETWORK  PORTION  OF  AN  INSURER'S
 NETWORK.
   §  3.  This  act  shall  take  effect on the same date and in the same
 manner as chapter 425 of the laws of 2016, takes effect, and shall apply
 to applications submitted on or after such date and shall not  apply  to
 applications  submitted prior to such date if such application is resub-
 mitted in substantially similar form on or after the effective  date  of
 this act.

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Senate Bill S1331

Sponsored By

Archive: Last Bill Status - In Senate Committee Insurance Committee

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co-Sponsors

2017-S1331 (ACTIVE) - Details

2017-S1331 (ACTIVE) - Summary

2017-S1331 (ACTIVE) - Sponsor Memo

2017-S1331 (ACTIVE) - Bill Text download pdf

Comments

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Sponsored By

David J. Valesky

Archive: Last Bill Status - In Senate Committee Insurance Committee

Actions

co-Sponsors

John A. DeFrancisco

Kemp Hannon

2017-S1331 (ACTIVE) - Details

2017-S1331 (ACTIVE) - Summary

2017-S1331 (ACTIVE) - Sponsor Memo

2017-S1331 (ACTIVE) - Bill Text download pdf

Comments