BILL NUMBER: S3282A
SPONSOR: RIVERA
 
TITLE OF BILL:
An act to amend the public health law and the insurance law, in relation
to health care professional applications and terminations
 
PURPOSE:
To establish a mediation process for physicians when a contract for
services is not renewed by a health plan.
 
SUMMARY OF SPECIFIC PROVISIONS:
This bill would authorize a physician or physician group practice to
initiate a mediation to resolve outstanding contractual issues that are
related to a non-renewal by a health plan for the physician to provide
in-network services. The mediation would have to occur 60 days prior to
the contract non-renewal. The mediator would be mutually agreed upon and
the results of the mediation would be non-binding. One week prior to the
mediation, the parties would be required to disclose to each other a
written statement on their position including any rationale for the
decision to to renew.
These provisions would apply to both publicly subsidized and private
health products that are regulated by New York State.
 
JUSTIFICATION:
The relationship between a patient and their physician is integral to
the effective and efficient provision of quality healthcare services.
The better a physician knows a patient, knows the patient's history, is
aware of the patient's level of participation in improving their own
health, and can meld these factors with the scientific practice of medi-
cine, the more likely the patient will receive the best and most effi-
cient healthcare.
As part of New York's Managed Care Bill of Rights, the Legislature
recognized the value gained by preserving the patient's relationships
with their provider by establishing meaningful due process protections
for all providers by prohibiting plans from terminating a provider with-
out notice and without an opportunity to be heard by a panel of clinical
peers. However, there have been instances where insurers have avoided
triggering these important protections by waiting to drop physicians
from their networks until the expiration of their participating contract
for reasons that may be related to these physicians challenging the
insurer's payment practices or the physician's referral of patients to
certain necessary specialists. This bill would establish protections for
contract non-renewals to assure that such non-renewals occur for valid
reasons.
 
LEGISLATIVE HISTORY:
2014: S.5762 Hannon/A.6498 Lavine
2015-16: S.4751 Hannon/A.1212 Lavine
2017-2018: S.3943 Hannon/A.2704 Lavine
2019-2020: S.3463/A.2835 Lavine
2021-2022: S.2528/A.4177 Lavine
2023-2024: S.3282/A.1777 Lavine
 
FISCAL IMPLICATIONS:
None.
 
EFFECTIVE DATE:
Takes effect on the 90th day following enactment.

Statutes affected:
S3282: 4406-c public health law, 4406-c(5-e) public health law, 3217-b insurance law, 3217-b(l) insurance law, 4325 insurance law, 4325(m) insurance law
S3282A: 4406-c public health law, 4406-c(5-e) public health law, 3217-b insurance law, 3217-b(l) insurance law, 4325 insurance law, 4325(m) insurance law