Senate Bill S7913

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7913
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                               May 13, 2025
                                ___________
 
 Introduced  by  Sen.  RIVERA -- 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
 PHYSICIAN,  podiatrist,  OPTOMETRIST, DENTIST, OR LICENSED MIDWIFE 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-CERTI-
 FIED 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.
                                                            LBD11839-01-5
              

 S. 7913                             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] SUCH HEALTH CARE
 PROFESSIONAL  is credentialed; or (ii) whether additional time is neces-
 sary 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, 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 documentation. A  HEALTH  CARE  PLAN  MAY  NOT  REFUSE  TO
 APPROVE AN APPLICATION FROM A PHYSICIAN, WHO WAS PREVIOUSLY BOARD-CERTI-
 FIED  AND  WHO  HAS NOT MAINTAINED 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] SUCH
 HEALTH CARE PROFESSIONAL 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 addi-
 tional 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 APPLICATION FROM A PHYSICIAN, WHO WAS PREVIOUSLY BOARD-CERTI-
 FIED 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.