NY State Senate Bill 2017-S7357A

Senate Bill S7357A

2017-2018 Legislative Session

Relates to improper practices relating to staff membership or professional privileges of a physician and such physician's board certification

download bill text pdf

Archive: Last Bill Status - In Senate Committee Health 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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Actions

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
May 03, 2018	print number 7357a
May 03, 2018	amend and recommit to health
Jan 09, 2018	referred to health

Bill Amendments

Original

A (Active)

2017-S7357 - Details

See Assembly Version of this Bill:: A4914
Current Committee:: Senate Health
Law Section:: Public Health Law
Laws Affected:: Amd §§2801-b & 4406-d, Pub Health L; amd §4803, Ins L
Versions Introduced in Other Legislative Sessions:: 2013-2014: A8979
2015-2016: A5650
2019-2020: S5280, A5140
2021-2022: S2116
2023-2024: S1727

2017-S7357 - Summary

Relates to improper practices relating to staff membership or professional privileges of a physician and such physician's board certification.

2017-S7357 - Sponsor Memo

                                
 
BILL NUMBER: S7357

SPONSOR: DEFRANCISCO
 
TITLE OF BILL:  An act to amend the public health law and the insur-
ance law, in relation to improper practices relating to staff membership
or professional privileges of a physician and board certification

 
PURPOSE:

An act to amend the public health law and the insurance law, in relation
to improper practices relating to the staff membership or professional
privileges of a physician and board certification.

 
SUMMARY OF PROVISIONS:

Section 1 of the bill would amend Section 2801-b of the Public Health
Law to prohibit the governing body of a hospital to refuse to grant
staff membership or professional privileges to a physician solely
because such physician is not board certified.

Section 2 of the bill would amend Section 4406-d of the Public Health

Law to prohibit an HMO from denying an application for participation in
the HMO's network solely because such physician is not board certified.

Section 3 of the bill would amend Section 4803 of the Insurance Law to
prohibit a health insurer from denying an application for participation
in that health insurer's network because such physician is not board
certified.

 
JUSTIFICATION:

The cost of obtaining and updating board certification status is
increasingly becoming prohibitively expensive for many physicians at a
time when they are already being squeezed between rapidly increasing
office overhead costs and cuts in insurer payment.  Physicians are
generally granted state medical licenses based upon successfully passing
medical school and internship examinations.  Beyond that, most physi-
cians aspire to obtain specialty board certification as it helps to
denote to the public that the physician is appropriately qualified to
treat various medical conditions typically treated by that specialty,
and advances in healthcare have required physicians to remain current in
their own specialty on a continuing basis. Physicians generally remain
current in their knowledge base by attending seminars, reading journals,
discussions with other physicians, and various other endeavors which are
designed to continually improve a physician's delivery of medical care.

Many also seek to achieve and continually update their board certif-
ication status. These various specialty boards belong to a parent organ-
ization, the American Board of Medical Specialties (ABMS), which has
become increasingly active in lobbying for recertification examinations
to be mandatory on a periodic basis throughout a physician's career.
While initial board certification is an important step in a physician's
development, recertification on a periodic basis is not only unneces-
sary, there is no evidence that such recertification actually improves
the delivery of healthcare.  Moreover, the costs are becoming increas-
ingly prohibitively expensive. For older physicians, the cost may drive
them out of practicing medicine altogether. This legislation would help
to ensure that board certification remains aspirational for physicians,
but not mandatory, by ensuring that hospitals and health insurance
companies cannot impose such requirements as a condition of partic-
ipation, thereby reducing one barrier to delivering medical care in New
York State.

 
LEGISLATIVE HISTORY:

2015-2016: A.5650.
2013-2014: A. 8979.

 
FISCAL IMPLICATIONS:

None.

 
LOCAL FISCAL IMPLICATIONS:

None,.

 
EFFECTIVE DATE:
Immediately.

2017-S7357 - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7357
 
                             I N  S E N A T E
 
                              January 9, 2018
                                ___________
 
 Introduced  by  Sen.  DeFRANCISCO -- read twice and ordered printed, and
   when printed to be committed 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.
   § 2. Paragraph (a) of subdivision 1 of section 4406-d  of  the  public
 health law, as amended by chapter 425 of the laws of 2016, 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
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets

                       [ ] is old law to be omitted.
                                                            LBD09068-05-8

 S. 7357                             2
 
 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 sixty 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
 because  of  a  failure of a third party to provide necessary documenta-
 tion. In such instances where additional time is necessary because of  a
 lack  of  necessary documentation, a health plan shall make every effort
 to obtain such information as soon as possible and shall  make  a  final
 determination within twenty-one days of receiving the necessary documen-
 tation. 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.
   § 3. Paragraph 1 of subsection (a) of section 4803  of  the  insurance
 law,  as  amended by chapter 425 of the laws of 2016, 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 sixty days of receiving a health care professional'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 because of a failure of a third party to provide necessary
 documentation. 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  and  shall
 make  a  final  determination  within  twenty-one  days of receiving the
 necessary documentation. AN INSURER MAY NOT REFUSE TO APPROVE AN  APPLI-
 CATION  FROM  A PHYSICIAN FOR PARTICIPATION IN THE IN-NETWORK PORTION OF
 THE INSURER'S NETWORK SOLELY BECAUSE SUCH PHYSICIAN IS NOT  BOARD-CERTI-
 FIED.
   § 4. This act shall take effect immediately.

2017-S7357A (ACTIVE) - Details

See Assembly Version of this Bill:: A4914
Current Committee:: Senate Health
Law Section:: Public Health Law
Laws Affected:: Amd §§2801-b & 4406-d, Pub Health L; amd §4803, Ins L
Versions Introduced in Other Legislative Sessions:: 2013-2014: A8979
2015-2016: A5650
2019-2020: S5280, A5140
2021-2022: S2116
2023-2024: S1727

2017-S7357A (ACTIVE) - Summary

Relates to improper practices relating to staff membership or professional privileges of a physician and such physician's board certification.

2017-S7357A (ACTIVE) - Sponsor Memo

                                
 
BILL NUMBER: S7357A

SPONSOR: DEFRANCISCO
 
TITLE OF BILL:

An act to amend the public health law and the insurance law, in relation
to improper practices relating to staff membership or professional priv-
ileges of a physician and board certification

 
PURPOSE:

To prohibit health insurance companies and hospitals from mandating that
their network and staff physicians continue to maintain board board
certification as a condition of participating in their panels and
medical staffs.

 
SUMMARY OF PROVISIONS:

Section 1 of the bill would amend Section 2801-b of the Public Health
Law to prohibit the governing body of a hospital to refuse to grant
staff membership or professional privileges to a physician who was

previously board-certified solely because such physician has not main-
tained such board certification.

Section 2 of the bill would amend Section 4406-d of the Public Health
Law to prohibit an HMO from denying an application for participation in
the HMO's network to a physician who was previously board-certified
solely because such physician has not maintained such board certif-
ication.

Section 3 of the bill would amend Section 4803 of the Insurance Law to
prohibit a health insurer from denying an application for participation
in that health insurer's network to a physician who was previously
board-certified solely because such physician has not maintained such
board certification.

Section 4 - Effective date

 
JUSTIFICATION:

The cost of obtaining and updating board certification status is
increasingly becoming prohibitively expensive for many physicians at a
time when they are already being squeezed between rapidly increasing
office overhead costs and cuts in insurer payment. Physicians are gener-
ally granted state medical licenses based upon successfully passing
medical school and internship examinations.  Beyond that, most physi-
cians aspire to obtain specialty board certification as it helps to
denote to the public that the physician is appropriately qualified to
treat various medical conditions typically treated by that specialty,
and advances in healthcare have required physicians to remain current in
their own specialty on a continuing basis. Physicians generally remain
current in their knowledge base by attending seminars, reading journals,
discussions with other physicians, and various other endeavors which are
designed to continually improve a physician's delivery of medical care.

Many also seek to achieve and continually update their board certif-
ication status. These various specialty boards belong to a parent organ-
ization, the American Board of Medical Specialties (ABMS), which has
become increasingly active in lobbying for recertification examinations
to be mandatory on a periodic basis throughout a physician's career.
While initial board certification is an important step in a physician's
development, recertification on a periodic basis is not only unneces-
sary, there is no evidence that such recertification actually improves
the delivery of healthcare.  Moreover, the costs are becoming increas-
ingly prohibitively expensive. For older physicians, the cost may drive
them out of practicing medicine altogether. This legislation would help
to ensure that board certification remains aspirational for physicians,
but not mandatory, by ensuring that hospitals and health insurance
companies cannot impose such requirements as a condition of partic-
ipation, thereby reducing one barrier to delivering medical care in New
York State.

 
LEGISLATIVE HISTORY:

2015-2016: A.5650;
2013-2014: A. 8979.

 
FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
This act shall take effect immediately.

2017-S7357A (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  7357--A
 
                             I N  S E N A T E
 
                              January 9, 2018
                                ___________
 
 Introduced  by  Sen.  DeFRANCISCO -- read twice and ordered printed, and
   when printed to be committed to the Committee on Health  --  committee
   discharged, bill amended, ordered reprinted as amended and recommitted
   to said committee
 
 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 WHO WAS PREVIOUSLY
 BOARD-CERTIFIED AND WHO HAS NOT  MAINTAINED  SUCH  CERTIFICATION  SOLELY
 BECAUSE SUCH PHYSICIAN IS NOT BOARD-CERTIFIED.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD09068-07-8

 S. 7357--A                          2
 
   §  2.  Paragraph  (a) of subdivision 1 of section 4406-d of the public
 health law, as amended by chapter 425 of the laws of 2016, 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 sixty 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
 because  of  a  failure of a third party to provide necessary documenta-
 tion. In such instances where additional time is necessary because of  a
 lack  of  necessary documentation, a health plan shall make every effort
 to obtain such information as soon as possible and shall  make  a  final
 determination within twenty-one days of receiving the necessary documen-
 tation. A HEALTH CARE PLAN MAY NOT REFUSE TO APPROVE AN APPLICATION FROM
 A  PHYSICIAN,  WHO  WAS PREVIOUSLY BOARD-CERTIFIED AND WHO HAS NOT MAIN-
 TAINED SUCH CERTIFICATION, TO PARTICIPATE IN THE IN-NETWORK  PORTION  OF
 THE  HEALTH  CARE  PLAN'S  NETWORK  SOLELY BECAUSE SUCH PHYSICIAN IS NOT
 BOARD-CERTIFIED.
   § 3. Paragraph 1 of subsection (a) of section 4803  of  the  insurance
 law,  as  amended by chapter 425 of the laws of 2016, 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 sixty days of receiving a health care professional'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 because of a failure of a third party to provide necessary
 documentation. 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  and  shall
 make  a  final  determination  within  twenty-one  days of receiving the
 necessary documentation. AN INSURER MAY NOT REFUSE TO APPROVE AN  APPLI-
 CATION  FROM A PHYSICIAN, WHO WAS PREVIOUSLY BOARD-CERTIFIED AND WHO HAS
 NOT MAINTAINED SUCH CERTIFICATION, FOR PARTICIPATION IN  THE  IN-NETWORK
 PORTION  OF  THE  INSURER'S NETWORK SOLELY BECAUSE SUCH PHYSICIAN IS NOT
 BOARD-CERTIFIED.
   § 4. This act shall take effect immediately.

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