S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7730
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                               June 6, 2023
                                ___________
 
 Introduced by M. of A. JOYNER -- read once and referred to the Committee
   on Insurance
 
 AN  ACT  to amend the public health law, the insurance law and the work-
   ers' compensation law, in relation to utilization  review  agents  and
   independent medical examiners
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Section 206 of the public health law is amended  by  adding
 two new subdivisions 32 and 33 to read as follows:
   32.  THE COMMISSIONER IS HEREBY DIRECTED TO ESTABLISH AND PERIODICALLY
 UPDATE FROM AVAILABLE APPLICANTS AN INDEPENDENT POOL OF  PHYSICIANS  AND
 PROFESSIONAL  HEALTH  SERVICE PROVIDERS IN EACH MEDICAL AND PROFESSIONAL
 HEALTH SERVICE SPECIALTY TO  SERVE  AS  INDEPENDENT  UTILIZATION  REVIEW
 AGENTS  AS  DEFINED BY SUBDIVISION NINE OF SECTION FORTY-NINE HUNDRED OF
 THIS CHAPTER. SUCH APPLICANT SHALL, UPON SUBMITTING THEIR  NAME  TO  THE
 COMMISSIONER,  CERTIFY  IN  WRITING THAT THEY WILL MAKE ALL DECISIONS ON
 CASES BEFORE THEM IN A FAIR AND UNBIASED MANNER, BASED  UPON  THE  FACTS
 PRESENTED TO THEM, AND WITHOUT ANY PRECONCEIVED BIAS, PRESSURE OR INFLU-
 ENCES  ASSERTED  FROM  OUTSIDE  ELEMENTS OR PRIOR EXPERIENCES OR WORK. A
 LICENSED PHYSICIAN SHALL PRESUME TO BE ELIGIBLE TO APPLY  FOR  INCLUSION
 IN  THE  POOL,  UNLESS  THE COMMISSIONER FINDS EXTENUATING CIRCUMSTANCES
 DICTATE THEIR DISQUALIFICATION.
   33. (A) THE COMMISSIONER SHALL ASSIGN PHYSICIANS OR OTHER PROFESSIONAL
 HEALTH SERVICE PROVIDERS AUTHORIZED TO EXAMINE  OR  EVALUATE  INJURY  OR
 ILLNESS  FROM THE POOL IN THE APPROPRIATE MEDICAL OR PROFESSIONAL HEALTH
 SERVICE SPECIALTY AND WHO PRACTICES IN  THE  SAME  AREA  OR  REGION,  TO
 CONDUCT  PHYSICAL  EXAMINATIONS  AND  REVIEW  MEDICAL RECORDS OF COVERED
 PERSONS EXCLUSIVELY ON A RANDOM, ROTATING BASIS  TO  ELIMINATE  BIAS  OR
 PREFERENCE IN THE SELECTION OF INDEPENDENT UTILIZATION REVIEW AGENTS, OR
 ALTERNATIVELY, THE COMMISSIONER MAY SELECT A NOT-FOR-PROFIT ORGANIZATION
 TO ASSIGN PROVIDERS FROM THE POOL ON THE SAME BASIS. SUCH ASSIGNMENT MAY
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD10457-01-3
              

 A. 7730                             2
 
 BE DONE THROUGH A PROCESS WHEREBY A LIST OF RANDOMLY SELECTED, APPROPRI-
 ATE  MEDICAL  OR  PROFESSIONAL  HEALTH  SERVICE PROVIDERS IS COMPILED BY
 GEOGRAPHIC REGION THROUGHOUT THE STATE AND  PROVIDED  TO  THE  INSURANCE
 CARRIER  AND  THE  CLAIMANT  FOR  THE PURPOSES OF PROVIDING BOTH PARTIES
 EQUAL OPPORTUNITY TO REJECT NO MORE THAN TWO NAMES OFF SUCH LIST  BEFORE
 THE  NEXT  AVAILABLE UTILIZATION REVIEW AGENT ON THE LIST IS SELECTED TO
 CONDUCT THE MEDICAL EXAMINATION OR REVIEW OF MEDICAL  RECORDS.  WHERE  A
 PERSON  IS  REJECTED  BY EITHER PARTY SUCH NAME SHALL HOWEVER RETAIN ITS
 PLACE IN THE ROTATION FOR PURPOSES OF FUTURE ASSIGNMENTS.
   (B) WHEN A UTILIZATION REVIEW AGENT IS SELECTED FROM THE POOL OF QUAL-
 IFIED UTILIZATION  REVIEW  AGENTS  MAINTAINED  BY  THE  DEPARTMENT,  THE
 COMMISSIONER  SHALL  REMOVE SUCH ASSIGNEE FROM ITS THEN CURRENT PLACE IN
 THE ROTATION AND PLACE SUCH AGENT'S NAME AT THE END OF THE POOL SO  THAT
 SUCH  AGENT  MAY  BE  AVAILABLE  FOR ANOTHER REGIONAL UTILIZATION REVIEW
 AGENT ASSIGNMENT AS NEEDED.
   (C) A PRACTITIONER IS NOT ELIGIBLE TO PERFORM A UTILIZATION REVIEW  OF
 A  COVERED PERSON WHEN THE APPEARANCE OF OR AN ACTUAL CONFLICT OF INTER-
 EST EXISTS. A CONFLICT OF INTEREST SHALL INCLUDE, BUT NOT BE LIMITED TO,
 INSTANCES WHERE THE UTILIZATION REVIEW AGENT OR SOMEONE IN THEIR  OFFICE
 OR  PLACE  OF EMPLOYMENT OR PRACTICE HAS TREATED OR EXAMINED THE COVERED
 PERSON. A CONFLICT OF INTEREST MAY BE PRESUMED TO EXIST WHEN THE  UTILI-
 ZATION  REVIEW AGENT AND A TREATING PROVIDER THAT PREVIOUSLY TREATED THE
 COVERED PERSON HAVE A RELATIONSHIP WHICH INVOLVES A DIRECT  OR  SUBSTAN-
 TIAL FINANCIAL INTEREST.
   (D)  A UTILIZATION REVIEW AGENT SHALL NOT BECOME THE TREATING PROVIDER
 FOR THE COVERED PERSON UNLESS AUTHORIZED TO DO SO BY  THE  COMMISSIONER,
 OR ORDERED TO BY AN ADMINISTRATIVE LAW JUDGE.
   (E)  A  PARTY  MAY,  WITHIN FIVE BUSINESS DAYS OF THE APPOINTMENT AS A
 UTILIZATION REVIEW AGENT FOR A PARTICULAR COVERED PERSON,  REQUEST  THAT
 THE  UTILIZATION REVIEW AGENT DISCLOSE ALL POTENTIAL CONFLICTS OF INTER-
 EST TO THE COMMISSIONER THAT MAY RESULT FROM  ANY  RELATIONSHIP  BETWEEN
 THE  UTILIZATION  REVIEW  AGENT  AND THE INSURANCE CARRIER, SELF-INSURED
 EMPLOYER, OR THE COVERED PERSON. A POTENTIAL CONFLICT OF INTEREST EXISTS
 WHEN THE UTILIZATION REVIEW AGENT, OR SOMEONE IN THEIR IMMEDIATE FAMILY,
 RECEIVES SOMETHING OF MATERIAL VALUE FROM THE INSURANCE CARRIER  WHETHER
 IN  THE  FORM OF STOCK, ROYALTIES, CONSULTANTSHIP, FUNDING BY A RESEARCH
 GRANT, OR OTHER PAYMENT BY THE  INSURANCE  CARRIER  FOR  ANY  ADDITIONAL
 SERVICE  OTHER THAN THE UTILIZATION REVIEW, OR IF THE UTILIZATION REVIEW
 AGENT RECEIVES MORE THAN FIFTY PERCENT OF HIS OR HER TOTAL EARNED INCOME
 BY PROVIDING UTILIZATION REVIEWS. SUCH REQUEST SHALL  BE  SUBMITTED,  IN
 WRITING,  TO  THE  COMMISSIONER  AND A COPY SHALL BE SENT, DELIVERED, OR
 SUBMITTED TO ANY OTHER PARTIES  AT  SUBSTANTIALLY  THE  SAME  TIME.  THE
 COMMISSIONER  SHALL DETERMINE WHETHER ANY CONFLICT OF INTEREST IS SUFFI-
 CIENTLY MATERIAL AS  TO  REQUIRE  DISQUALIFICATION  OF  THE  UTILIZATION
 REVIEW  AGENT FROM PERFORMING ANY UTILIZATION REVIEW UNDER THIS ARTICLE,
 AFTER PROMPT DISCLOSURE PURSUANT TO THIS SUBDIVISION.
   § 2. Subdivision 2 of section 4902 of the public health law, as  added
 by chapter 705 of the laws of 1996, is amended to read as follows:
   2.  Each  utilization  review  agent  shall  assure  adherence  to the
 requirements stated in subdivision one of this section by  all  contrac-
 tors,  subcontractors,  subvendors,  agents  and employees affiliated by
 contract or otherwise with such utilization review agent,   AND    SHALL
 CONDUCT  ALL  REVIEWS  IN AN OBJECTIVE AND IMPARTIAL MANNER. UTILIZATION
 REVIEW AGENTS SHALL HAVE THEIR RECORDS  RANDOMLY  REVIEWED  AND  AUDITED
 PERIODICALLY   BY  THE COMMISSIONER. THE COMMISSIONER  SHALL  BE AUTHOR-
 IZED TO CONDUCT A RANDOM REVIEW OF NO MORE THAN FIVE UTILIZATION  REVIEW
 A. 7730                             3
 
 AGENT RECORDS  DURING  AN AGENT'S  REGISTRATION PERIOD. IF, IN THE OPIN-
 ION  OF  THE  COMMISSIONER,  THREE  OR  MORE  OF THE AGENT'S RECORDS AND
 DOCUMENTATION OUT OF THE FIVE RECORDS THAT MAY BE AUDITED  ANNUALLY  ARE
 JUDGED  TO  BE DEFICIENT,  THE COMMISSIONER SHALL BE AUTHORIZED TO AUDIT
 ADDITIONAL RECORDS DURING SUCH REGISTRATION PERIOD AND SHALL  BE AUTHOR-
 IZED TO INSTITUTE A REMEDIAL PROGRAM PRIOR  TO  THE  EXPIRATION  OF  THE
 REGISTRANT'S  CURRENT REGISTRATION PERIOD. IF DURING ANY TWO CONSECUTIVE
 ANNUAL AUDIT PERIODS AN AGENT'S RECORDS AND DOCUMENTATION ARE JUDGED  TO
 BE  DEFICIENT  IN SPITE  OF  ANY  PROGRAM  OF  REMEDIAL  ACTION DIRECTED
 ON THE PART OF THE COMMISSIONER, THE COMMISSIONER MAY REMOVE THE  UTILI-
 ZATION REVIEW AGENT FROM THE POOL OF NAMES AVAILABLE TO CONDUCT UTILIZA-
 TION  REVIEWS.  ONCE A REGISTRANT'S NAME HAS BEEN REMOVED FROM THE POOL,
 IN ORDER TO RE-REGISTER AS AN AGENT THE REGISTRANT SHALL  SEEK  AUTHORI-
 ZATION IN ACCORDANCE WITH THIS CHAPTER AND IN THE SAME MANNER AS A PRAC-
 TITIONER WHO HAS NOT PREVIOUSLY BEEN AUTHORIZED.
   §  3.  The  insurance law is amended by adding a new section 4901-a to
 read as follows:
   § 4901-A. IMPARTIALITY OF UTILIZATION REVIEW AGENTS.  (A)  THE  SUPER-
 INTENDENT  IS  HEREBY DIRECTED TO ESTABLISH AND PERIODICALLY UPDATE FROM
 AVAILABLE APPLICANTS AN INDEPENDENT POOL OF PHYSICIANS AND  PROFESSIONAL
 HEALTH SERVICE PROVIDERS IN EACH MEDICAL AND PROFESSIONAL HEALTH SERVICE
 SPECIALTY  TO  SERVE AS INDEPENDENT UTILIZATION REVIEW AGENTS AS DEFINED
 BY SUBSECTION (I) OF SECTION FORTY-NINE  HUNDRED  OF  THIS  TITLE.  SUCH
 APPLICANT  SHALL,  UPON  SUBMITTING  THEIR  NAME  TO THE SUPERINTENDENT,
 CERTIFY IN WRITING THAT THEY WILL MAKE ALL  DECISIONS  ON  CASES  BEFORE
 THEM  IN  A  FAIR AND UNBIASED MANNER, BASED UPON THE FACTS PRESENTED TO
 THEM, AND WITHOUT ANY PRECONCEIVED BIAS, PRESSURE OR INFLUENCES ASSERTED
 FROM OUTSIDE ELEMENTS OR PRIOR EXPERIENCES OR WORK. A LICENSED PHYSICIAN
 SHALL PRESUME TO BE ELIGIBLE TO APPLY FOR INCLUSION IN THE POOL,  UNLESS
 THE   SUPERINTENDENT   FINDS  EXTENUATING  CIRCUMSTANCES  DICTATE  THEIR
 DISQUALIFICATION.
   (B)(1) THE SUPERINTENDENT SHALL ASSIGN  PHYSICIANS  OR  OTHER  PROFES-
 SIONAL HEALTH SERVICE PROVIDERS AUTHORIZED TO EXAMINE OR EVALUATE INJURY
 OR  ILLNESS  FROM  THE  POOL  IN THE APPROPRIATE MEDICAL OR PROFESSIONAL
 HEALTH SERVICE SPECIALTY AND WHO PRACTICES IN THE SAME AREA OR REGION TO
 CONDUCT PHYSICAL EXAMINATIONS AND  REVIEW  MEDICAL  RECORDS  OF  COVERED
 PERSONS  EXCLUSIVELY  ON  A  RANDOM, ROTATING BASIS TO ELIMINATE BIAS OR
 PREFERENCE IN  THE  SELECTION  OF  THE  INDEPENDENT  UTILIZATION  REVIEW
 AGENTS, OR ALTERNATIVELY, THE SUPERINTENDENT MAY SELECT A NOT-FOR-PROFIT
 ORGANIZATION  TO  ASSIGN PROVIDERS FROM THE POOL ON THE SAME BASIS. SUCH
 ASSIGNMENT MAY BE DONE THROUGH A PROCESS  WHEREBY  A  LIST  OF  RANDOMLY
 SELECTED,  APPROPRIATE  MEDICAL OR PROFESSIONAL HEALTH SERVICE PROVIDERS
 IS COMPILED BY GEOGRAPHIC REGION THROUGHOUT THE STATE  AND  PROVIDED  TO
 THE  INSURANCE  CARRIER  AND  THE CLAIMANT FOR THE PURPOSES OF PROVIDING
 BOTH PARTIES EQUAL OPPORTUNITY TO REJECT NO MORE THAN TWO NAMES OFF SUCH
 LIST UNTIL ONE UTILIZATION REVIEW AGENT REMAINS TO CONDUCT  THE  MEDICAL
 EXAMINATION  OR  REVIEW OF MEDICAL RECORDS. WHEN A PERSON IS REJECTED BY
 EITHER PARTY SUCH NAME SHALL HOWEVER RETAIN ITS PLACE  IN  THE  ROTATION
 FOR PURPOSES OF FUTURE ASSIGNMENTS.
   (2) WHEN A UTILIZATION REVIEW AGENT IS SELECTED FROM THE POOL OF QUAL-
 IFIED UTILIZATION REVIEW AGENTS MAINTAINED BY THE DEPARTMENT, THE SUPER-
 INTENDENT  SHALL  REMOVE  SUCH  UTILIZATION REVIEW AGENT'S NAME FROM ITS
 THEN CURRENT PLACE IN THE ROTATION AND PLACE SUCH AGENT'S  NAME  AT  THE
 END OF THE POOL SO THAT SUCH AGENT MAY BE AVAILABLE FOR ANOTHER REGIONAL
 UTILIZATION REVIEW AGENT ASSIGNMENT AS NEEDED.
 A. 7730                             4
 
   (3)  A PRACTITIONER IS NOT ELIGIBLE TO PERFORM A UTILIZATION REVIEW OF
 A COVERED PERSON WHEN THE APPEARANCE OF OR AN ACTUAL CONFLICT OF  INTER-
 EST EXISTS. A CONFLICT OF INTEREST SHALL INCLUDE, BUT NOT BE LIMITED TO,
 INSTANCES  WHERE THE UTILIZATION REVIEW AGENT OR SOMEONE IN THEIR OFFICE
 OR  PLACE  OF EMPLOYMENT OR PRACTICE HAS TREATED OR EXAMINED THE COVERED
 PERSON. A CONFLICT OF INTEREST MAY BE PRESUMED TO EXIST WHEN THE  UTILI-
 ZATION  REVIEW AGENT AND A TREATING PROVIDER THAT PREVIOUSLY TREATED THE
 COVERED PERSON HAVE A RELATIONSHIP WHICH INVOLVES A DIRECT  OR  SUBSTAN-
 TIAL FINANCIAL INTEREST.
   (4)  A UTILIZATION REVIEW AGENT SHALL NOT BECOME THE TREATING PROVIDER
 FOR THE COVERED PERSON UNLESS AUTHORIZED TO DO SO BY THE COMMISSIONER OF
 HEALTH, OR ORDERED TO BY AN ADMINISTRATIVE LAW JUDGE.
   (5) A PARTY MAY, WITHIN FIVE BUSINESS DAYS OF  THE  APPOINTMENT  AS  A
 UTILIZATION  REVIEW  AGENT FOR A PARTICULAR COVERED PERSON, REQUEST THAT
 THE UTILIZATION REVIEW AGENT DISCLOSE ALL POTENTIAL CONFLICTS OF  INTER-
 EST  TO THE SUPERINTENDENT THAT MAY RESULT FROM ANY RELATIONSHIP BETWEEN
 THE UTILIZATION REVIEW AGENT AND  THE  INSURANCE  CARRIER,  SELF-INSURED
 EMPLOYER, OR THE COVERED PERSON. A POTENTIAL CONFLICT OF INTEREST EXISTS
 WHEN THE UTILIZATION REVIEW AGENT, OR SOMEONE IN THEIR IMMEDIATE FAMILY,
 RECEIVES  SOMETHING OF MATERIAL VALUE FROM THE INSURANCE CARRIER WHETHER
 IN THE FORM OF STOCK, ROYALTIES, CONSULTANTSHIP, FUNDING BY  A  RESEARCH
 GRANT,  OR  OTHER  PAYMENT  BY  THE INSURANCE CARRIER FOR ANY ADDITIONAL
 SERVICE OTHER THAN THE UTILIZATION REVIEW, OR IF THE UTILIZATION  REVIEW
 AGENT RECEIVES MORE THAN FIFTY PERCENT OF HIS OR HER TOTAL EARNED INCOME
 BY  PROVIDING  UTILIZATION  REVIEWS. SUCH REQUEST SHALL BE SUBMITTED, IN
 WRITING, TO THE SUPERINTENDENT AND A COPY SHALL BE SENT,  DELIVERED,  OR
 SUBMITTED  TO  ANY  OTHER  PARTIES  AT  SUBSTANTIALLY THE SAME TIME. THE
 SUPERINTENDENT SHALL DETERMINE  WHETHER  ANY  CONFLICT  OF  INTEREST  IS
 SUFFICIENTLY  MATERIAL AS TO REQUIRE DISQUALIFICATION OF THE UTILIZATION
 REVIEW AGENT FROM PERFORMING ANY UTILIZATION REVIEW UNDER THIS  ARTICLE,
 AFTER PROMPT DISCLOSURE PURSUANT TO THIS SUBDIVISION.
   §  4. Subsection (b) of section 4902 of the insurance law, as added by
 chapter 705 of the laws of 1996, is amended to read as follows:
   (b) Each utilization  review  agent  shall  assure  adherence  to  the
 requirements  stated  in  subsection (a) of this section by all contrac-
 tors, subcontractors, subvendors, agents  and  employees  affiliated  by
 contract  or  otherwise  with  such  utilization review agent, AND SHALL
 CONDUCT ALL REVIEWS IN AN OBJECTIVE AND IMPARTIAL MANNER.
   § 5. Section 4902 of the insurance law is amended by  adding  two  new
 subsections (c) and (d) to read as follows:
   (C)  UTILIZATION  REVIEW  AGENTS  SHALL  HAVE  THEIR  RECORDS RANDOMLY
 REVIEWED AND AUDITED PERIODICALLY BY BOTH THE SUPERINTENDENT  OF  FINAN-
 CIAL  SERVICES  AND  THE  COMMISSIONER OF HEALTH. THE SUPERINTENDENT AND
 COMMISSIONER SHALL BE AUTHORIZED TO CONDUCT A RANDOM REVIEW OF  NO  MORE
 THAN  FIVE  UTILIZATION  REVIEW  RECORDS  ANNUALLY  DURING A UTILIZATION
 REVIEW AGENT'S REGISTRATION PERIOD. IF, IN THE  OPINION  OF  THE  SUPER-
 INTENDENT  AND  COMMISSIONER,  THREE  OR  MORE OF THE UTILIZATION REVIEW
 AGENT'S RECORDS AND DOCUMENTATION OUT OF THE FIVE RECORDS  THAT  MAY  BE
 AUDITED  ANNUALLY  ARE  JUDGED  TO BE DEFICIENT, SUCH SUPERINTENDENT AND
 COMMISSIONER SHALL BE AUTHORIZED TO AUDIT ADDITIONAL RECORDS DURING SUCH
 REGISTRATION PERIOD AND SHALL BE  AUTHORIZED  TO  INSTITUTE  A  REMEDIAL
 PROGRAM PRIOR TO THE EXPIRATION OF THE REGISTRANT'S CURRENT REGISTRATION
 PERIOD. IF DURING ANY TWO CONSECUTIVE ANNUAL AUDIT PERIODS A UTILIZATION
 REVIEW  AGENT'S  RECORDS AND DOCUMENTATION ARE JUDGED TO BE DEFICIENT IN
 SPITE OF ANY PROGRAM OF REMEDIAL ACTION DIRECTED  ON  THE  PART  OF  THE
 SUPERINTENDENT  AND COMMISSIONER, THEY MAY REMOVE THE UTILIZATION REVIEW
 A. 7730                             5

 AGENT FROM THE POOL OF NAMES AVAILABLE TO CONDUCT  UTILIZATION  REVIEWS.
 ONCE  A  REGISTRANT'S  NAME  HAS BEEN REMOVED FROM THE POOL, IN ORDER TO
 RE-REGISTER AS A UTILIZATION REVIEW  AGENT  THE  REGISTRANT  SHALL  SEEK
 AUTHORIZATION  IN ACCORDANCE WITH THIS ARTICLE AND IN THE SAME MANNER AS
 A PRACTITIONER WHO HAS NOT PREVIOUSLY BEEN AUTHORIZED.
   (D) THE UTILIZATION REVIEW AGENT SHALL  CITE,  WHENEVER  AND  WHEREVER
 POSSIBLE,  THE  SPECIFIC  PAGE  AND  REFERENCE  TO THE RELEVANT PRACTICE
 GUIDELINE OR TO THE RELEVANT PEER-REVIEWED MEDICAL LITERATURE, SCIENTIF-
 IC STUDIES, ABSTRACTS, AND/OR STANDARD  REFERENCE  COMPENDIA,  THAT  THE
 AGENT  UTILIZED  TO  ASSIST  HIM OR HER IN REACHING A DETERMINATION WHEN
 COMMENTING ON  OR  MAKING  ANY  DETERMINATION  ADVERSE  TO  THE  COVERED
 PERSONS' ONGOING OR CONCURRENT CARE OR A RETROSPECTIVE REVIEW BASED ON A
 REVIEW  OF  THE  TREATING  PROVIDER'S  RECORDS  OR AN EXAMINATION OF THE
 INJURED PATIENT OR COVERED PERSON.
   § 6. Subsection (c) of section 4905 of the insurance law, as added  by
 chapter 705 of the laws of 1996, is amended to read as follows:
   (c)  EACH  UTILIZATION  REVIEW  AGENT, OR CONTRACTORS, SUBCONTRACTORS,
 SUBVENDORS, AGENTS AND EMPLOYEES AFFILIATED  BY  CONTRACT  OR  OTHERWISE
 WITH  SUCH  UTILIZATION  REVIEW  AGENT,  SHALL CONDUCT ALL REVIEWS IN AN
 OBJECTIVE AND IMPARTIAL MANNER. Any health care professional  who  makes
 determinations  regarding  the medical necessity of health care services
 during the course of utilization review shall be appropriately licensed,
 registered or certified.
   § 7. Section 4905 of the insurance law is amended by adding three  new
 subsections (p), (q), and (r) to read as follows:
   (P)  A PRACTITIONER IS NOT ELIGIBLE TO PERFORM A UTILIZATION REVIEW OF
 A COVERED PERSON WHEN THE APPEARANCE OF OR AN ACTUAL CONFLICT OF  INTER-
 EST EXISTS. A CONFLICT OF INTEREST SHALL INCLUDE, BUT NOT BE LIMITED TO,
 INSTANCES  WHERE THE UTILIZATION REVIEW AGENT OR SOMEONE IN THEIR OFFICE
 OR PLACE OF EMPLOYMENT OR PRACTICE HAS TREATED OR EXAMINED  THE  COVERED
 PERSON.  A CONFLICT OF INTEREST MAY BE PRESUMED TO EXIST WHEN THE UTILI-
 ZATION REVIEW AGENT AND A PROVIDER THAT PREVIOUSLY TREATED  THE  COVERED
 PERSON HAVE A RELATIONSHIP WHICH INVOLVES A DIRECT OR SUBSTANTIAL FINAN-
 CIAL INTEREST.
   (Q)  A UTILIZATION REVIEW AGENT SHALL NOT BECOME THE TREATING PROVIDER
 FOR THE COVERED PERSON UNLESS AUTHORIZED TO DO SO BY THE COMMISSIONER OF
 HEALTH, OR ORDERED TO BY AN ADMINISTRATIVE LAW JUDGE.
   (R) A PARTY MAY, WITHIN FIVE BUSINESS DAYS OF  THE  APPOINTMENT  AS  A
 UTILIZATION  REVIEW  AGENT FOR A PARTICULAR COVERED PERSON, REQUEST THAT
 THE UTILIZATION REVIEW AGENT DISCLOSE ALL POTENTIAL CONFLICTS OF  INTER-
 EST  TO THE SUPERINTENDENT THAT MAY RESULT FROM ANY RELATIONSHIP BETWEEN
 THE UTILIZATION REVIEW AGENT AND  THE  INSURANCE  CARRIER,  SELF-INSURED
 EMPLOYER, OR THE COVERED PERSON. A POTENTIAL CONFLICT OF INTEREST EXISTS
 WHEN THE UTILIZATION REVIEW AGENT, OR SOMEONE IN THEIR IMMEDIATE FAMILY,
 RECEIVES  SOMETHING OF MATERIAL VALUE FROM THE INSURANCE CARRIER WHETHER
 IN THE FORM OF STOCK, ROYALTIES, CONSULTANTSHIP, FUNDING BY  A  RESEARCH
 GRANT,  OR  OTHER  PAYMENT  BY  THE INSURANCE CARRIER FOR ANY ADDITIONAL
 SERVICE OTHER THAN THE UTILIZATION REVIEW, OR IF THE UTILIZATION  REVIEW
 AGENT RECEIVES MORE THAN FIFTY PERCENT OF HIS OR HER TOTAL EARNED INCOME
 BY  PROVIDING  UTILIZATION  REVIEWS. SUCH REQUEST SHALL BE SUBMITTED, IN
 WRITING, TO THE SUPERINTENDENT AND A COPY SHALL BE SENT,  DELIVERED,  OR
 SUBMITTED  TO  ANY  OTHER  PARTIES  AT  SUBSTANTIALLY THE SAME TIME. THE
 SUPERINTENDENT SHALL DETERMINE  WHETHER  ANY  CONFLICT  OF  INTEREST  IS
 SUFFICIENTLY  MATERIAL AS TO REQUIRE DISQUALIFICATION OF THE UTILIZATION
 REVIEW AGENT FROM PERFORMING ANY UTILIZATION REVIEW UNDER THIS  ARTICLE,
 AFTER PROMPT DISCLOSURE PURSUANT TO THIS SUBDIVISION.
 A. 7730                             6
 
   §  8.  Subdivision 3 of section 13-b of the workers' compensation law,
 as amended by section 1 of part CC of chapter 55 of the laws of 2019, is
 amended to read as follows:
   3.  A  provider  properly  licensed or certified pursuant to the regu-
 lations of the commissioner of education and  the  requirements  of  the
 education  law desirous of being authorized to render medical care under
 this chapter and/or  to  conduct  independent  medical  examinations  in
 accordance  with paragraph (b) of subdivision four of section thirteen-a
 and section one hundred thirty-seven  of  this  chapter  shall  file  an
 application  for  authorization  under  this  chapter  with the chair or
 chair's designee.  Prior to receiving authorization, a  physician  must,
 together  with  submission  of  an application to the chair, submit such
 application to the medical society of the county  in  which  the  physi-
 cian's office is located or of a board designated by such county society
 or  of a board representing duly licensed physicians of any other school
 of medical practice in such  county,  and  such  medical  society  shall
 submit the recommendation to the board. In the event such county society
 or  board  fails  to take action upon a physician's completed and signed
 application within forty-five days, the chair may complete review of the
 application without such approval. Upon approval of the  application  by
 the  chair or the chair's designee, the applicant shall further agree to
 refrain from  subsequently  treating  for  remuneration,  as  a  private
 patient, any person seeking medical treatment, or submitting to an inde-
 pendent  medical examination, in connection with, or as a result of, any
 injury compensable under this chapter, if he or  she  has  been  removed
 from  the  list  of  providers  authorized  to render medical care or to
 conduct independent medical examinations under this chapter, or  if  the
 person  seeking  such treatment, or submitting to an independent medical
 examination, has been transferred from his or  her  care  in  accordance
 with  the  provisions of this chapter. THE APPLICANT SHALL ALSO AGREE TO
 CONDUCT ALL EXAMINATIONS IN AN  OBJECTIVE  AND  IMPARTIAL  MANNER.  This
 agreement  shall  run to the benefit of the injured person so treated or
 examined, and shall be available to him or  her  as  a  defense  in  any
 action by such provider for payment for treatment rendered by a provider
 after  he  or she has been removed from the list of providers authorized
 to render medical care or to conduct  independent  medical  examinations
 under this chapter, or after the injured person was transferred from his
 or her care in accordance with the provisions of this chapter.
   § 9. Section 137 of the workers' compensation law is amended by adding
 two new subdivisions 13 and 14 to read as follows:
   13.  EXAMINERS  SHALL HAVE THEIR RECORDS RANDOMLY REVIEWED AND AUDITED
 PERIODICALLY BY THE CHAIR. THE CHAIR SHALL BE AUTHORIZED  TO  CONDUCT  A
 RANDOM  REVIEW  OF  NO  MORE  THAN  FIVE INDEPENDENT MEDICAL EXAMINATION
 RECORDS DURING AN EXAMINER'S TRIENNIAL REGISTRATION PERIOD. IF,  IN  THE
 OPINION  OF  THE  CHAIR,  THREE  OR  MORE  OF THE EXAMINER'S RECORDS AND
 DOCUMENTATION OUT OF THE FIVE RECORDS THAT MAY BE AUDITED  ANNUALLY  ARE
 JUDGED  TO  BE  DEFICIENT,  THE CHAIR SHALL BE AUTHORIZED TO AUDIT ADDI-
 TIONAL RECORDS DURING SUCH REGISTRATION PERIOD AND SHALL  BE  AUTHORIZED
 TO  INSTITUTE  A  REMEDIAL PROGRAM PRIOR TO THE EXPIRATION OF THE REGIS-
 TRANT'S CURRENT INDEPENDENT MEDICAL EXAMINER REGISTRATION  PERIOD.    IF
 DURING  ANY  TWO  CONSECUTIVE ANNUAL AUDIT PERIODS AN EXAMINER'S RECORDS
 AND DOCUMENTATION ARE JUDGED TO BE DEFICIENT IN SPITE OF ANY PROGRAM  OF
 REMEDIAL  ACTION DIRECTED ON THE PART OF THE CHAIR, THE CHAIR MAY REMOVE
 THE EXAMINER FROM THE POOL OF NAMES  AVAILABLE  TO  CONDUCT  INDEPENDENT
 MEDICAL EXAMINATIONS. ONCE A REGISTRANT'S NAME HAS BEEN REMOVED FROM THE
 POOL,  IN  ORDER TO RE-REGISTER AS AN EXAMINER THE REGISTRANT SHALL SEEK
 A. 7730                             7
 
 AUTHORIZATION IN ACCORDANCE WITH SECTION THIRTEEN-B OF THIS CHAPTER  AND
 IN THE SAME MANNER AS A PRACTITIONER WHO HAS NOT PREVIOUSLY BEEN AUTHOR-
 IZED.
   14.  THE  EXAMINER  SHALL  CITE,  WHENEVER  AND WHEREVER POSSIBLE, THE
 SPECIFIC PAGE AND REFERENCE TO THE RELEVANT PRACTICE GUIDELINE OR TO THE
 RELEVANT   PEER-REVIEWED   MEDICAL   LITERATURE,   SCIENTIFIC   STUDIES,
 ABSTRACTS,  AND/OR  STANDARD  REFERENCE  COMPENDIA,  THAT  THE  EXAMINER
 UTILIZED TO ASSIST HIM OR HER IN REACHING A DETERMINATION WHEN  COMMENT-
 ING  ON OR MAKING ANY DETERMINATION ADVERSE TO THE CLAIMANT'S ONGOING OR
 CONCURRENT CARE OR A RETROSPECTIVE REVIEW  BASED  ON  A  REVIEW  OF  THE
 TREATING  PROVIDER'S RECORDS OR AN EXAMINATION OF THE INJURED PATIENT OR
 CLAIMANT.
   § 10. The workers' compensation law is amended by adding a new section
 137-a to read as follows:
   § 137-A. IMPARTIALITY OF  INDEPENDENT  MEDICAL  EXAMINATIONS.  1.  THE
 CHAIR  IS  HEREBY  DIRECTED  TO  ESTABLISH  AND PERIODICALLY UPDATE FROM
 AVAILABLE APPLICANTS AN INDEPENDENT POOL OF PHYSICIANS AND  PROFESSIONAL
 HEALTH SERVICE PROVIDERS IN EACH MEDICAL AND PROFESSIONAL HEALTH SERVICE
 SPECIALTY  TO  SERVE AS EXAMINERS. SUCH APPLICANT SHALL, UPON SUBMITTING
 THEIR NAME TO THE CHAIR, CERTIFY IN WRITING  THAT  THEY  WILL  MAKE  ALL
 DECISIONS ON CASES BEFORE THEM IN A FAIR AND UNBIASED MANNER, BASED UPON
 THE FACTS PRESENTED TO THEM, AND WITHOUT ANY PRECONCEIVED BIAS, PRESSURE
 OR  INFLUENCES  ASSERTED  FROM  OUTSIDE ELEMENTS OR PRIOR EXPERIENCES OR
 WORK. A LICENSED PHYSICIAN SHALL PRESUME TO BE  ELIGIBLE  TO  APPLY  FOR
 INCLUSION  IN THE POOL, UNLESS THE CHAIR FINDS EXTENUATING CIRCUMSTANCES
 DICTATE THEIR DISQUALIFICATION.
   2. (A) THE CHAIR SHALL ASSIGN PHYSICIANS OR OTHER PROFESSIONAL  HEALTH
 SERVICE  PROVIDERS  AUTHORIZED  TO EXAMINE OR EVALUATE INJURY OR ILLNESS
 FROM THE POOL IN THE APPROPRIATE MEDICAL OR PROFESSIONAL HEALTH  SERVICE
 SPECIALTY  AND WHO PRACTICES IN THE SAME AREA OR REGION TO CONDUCT PHYS-
 ICAL EXAMINATIONS AND REVIEW MEDICAL RECORDS OF COVERED  PERSONS  EXCLU-
 SIVELY  ON  A  RANDOM, ROTATING BASIS TO ELIMINATE BIAS OR PREFERENCE IN
 THE SELECTION OF THE EXAMINERS, OR ALTERNATIVELY, THE CHAIR MAY SELECT A
 NOT-FOR-PROFIT ORGANIZATION TO ASSIGN PROVIDERS FROM  THE  POOL  ON  THE
 SAME BASIS. SUCH ASSIGNMENT MAY BE DONE THROUGH A PROCESS WHEREBY A LIST
 OF RANDOMLY SELECTED, APPROPRIATE MEDICAL OR PROFESSIONAL HEALTH SERVICE
 PROVIDERS  IS  COMPILED  BY  GEOGRAPHIC  REGION THROUGHOUT THE STATE AND
 PROVIDED TO THE INSURANCE CARRIER AND THE CLAIMANT FOR THE  PURPOSES  OF
 PROVIDING  BOTH  PARTIES  EQUAL  OPPORTUNITY  TO REJECT NO MORE THAN TWO
 NAMES OFF SUCH LIST UNTIL ONE EXAMINER REMAINS TO CONDUCT THE  INDEPEND-
 ENT  MEDICAL EXAMINATION OR REVIEW OF MEDICAL RECORDS. WHERE A PERSON IS
 REJECTED BY EITHER PARTY SUCH NAME SHALL HOWEVER RETAIN ITS PLACE IN THE
 ROTATION FOR PURPOSES OF FUTURE ASSIGNMENTS.
   (B) WHEN AN EXAMINER IS SELECTED FROM THE POOL OF QUALIFIED  INDEPEND-
 ENT MEDICAL EXAMINERS MAINTAINED BY THE BOARD, THE CHAIRMAN SHALL REMOVE
 SUCH ASSIGNEE FROM ITS THEN CURRENT PLACE IN THE ROTATION AND PLACE SUCH
 AGENT'S  NAME AT THE END OF THE POOL SO THAT SUCH AGENT MAY BE AVAILABLE
 FOR ANOTHER REGIONAL UTILIZATION REVIEW AGENT ASSIGNMENT AS NEEDED.
   (C) A PRACTITIONER IS NOT ELIGIBLE TO PERFORM AN  INDEPENDENT  MEDICAL
 EXAMINATION  OF  A CLAIMANT WHEN THE APPEARANCE OF OR AN ACTUAL CONFLICT
 OF INTEREST EXISTS. A CONFLICT OF INTEREST SHALL  INCLUDE,  BUT  NOT  BE
 LIMITED  TO,  INSTANCES WHERE THE UTILIZATION REVIEW AGENT OR SOMEONE IN
 THEIR OFFICE OR PLACE OF EMPLOYMENT OR PRACTICE HAS TREATED OR  EXAMINED
 THE  CLAIMANT.  A CONFLICT OF INTEREST MAY BE PRESUMED TO EXIST WHEN THE
 EXAMINER AND A PROVIDER THAT PREVIOUSLY  TREATED  THE  CLAIMANT  HAVE  A
 RELATIONSHIP WHICH INVOLVES A DIRECT OR SUBSTANTIAL FINANCIAL INTEREST.
 A. 7730                             8
 
   (D)  AN EXAMINER SHALL NOT BECOME THE TREATING PROVIDER FOR THE CLAIM-
 ANT UNLESS AUTHORIZED TO DO SO BY THE CHAIR, OR ORDERED TO BY AN  ADMIN-
 ISTRATIVE LAW JUDGE.
   (E)  A  PARTY  MAY, WITHIN FIVE BUSINESS DAYS OF THE APPOINTMENT AS AN
 EXAMINER FOR A PARTICULAR CLAIMANT, REQUEST THAT THE  EXAMINER  DISCLOSE
 ALL POTENTIAL CONFLICTS OF INTEREST TO THE CHAIRMAN THAT MAY RESULT FROM
 ANY  RELATIONSHIP  BETWEEN THE EXAMINER AND THE INSURANCE CARRIER, SELF-
 INSURED EMPLOYER, OR THE CLAIMANT.  A  POTENTIAL  CONFLICT  OF  INTEREST
 EXISTS WHEN THE EXAMINER, OR SOMEONE IN THEIR IMMEDIATE FAMILY, RECEIVES
 SOMETHING  OF  MATERIAL  VALUE FROM THE INSURANCE CARRIER WHETHER IN THE
 FORM OF STOCK, ROYALTIES, CONSULTANTSHIP, FUNDING BY A  RESEARCH  GRANT,
 OR  OTHER  PAYMENT  BY  THE INSURANCE CARRIER FOR ANY ADDITIONAL SERVICE
 OTHER THAN THE INDEPENDENT  MEDICAL  EXAMINATION,  OR  IF  THE  EXAMINER
 RECEIVES  MORE  THAN  FIFTY PERCENT OF HIS OR HER TOTAL EARNED INCOME BY
 PROVIDING  INDEPENDENT  MEDICAL  EXAMINATIONS.  SUCH  REQUEST  SHALL  BE
 SUBMITTED, IN WRITING, TO THE CHAIR AND A COPY SHALL BE SENT, DELIVERED,
 OR  SUBMITTED  TO  ANY OTHER PARTIES AT SUBSTANTIALLY THE SAME TIME. THE
 CHAIR SHALL DETERMINE WHETHER ANY CONFLICT OF INTEREST  IS  SUFFICIENTLY
 MATERIAL  AS TO REQUIRE DISQUALIFICATION OF THE EXAMINER FROM PERFORMING
 ANY INDEPENDENT MEDICAL EXAMINATION UNDER  THIS  CHAPTER,  AFTER  PROMPT
 DISCLOSURE PURSUANT TO THIS SUBDIVISION.
   § 11. This act shall take effect immediately.