BILL NUMBER: S1911A
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 provide health care practitioners with due process protections in
order to allow and encourage a meaningful continuity of care to health
insurance enrollees.
 
SUMMARY OF PROVISIONS:
Section 1 amends section 4406-d of the Public Health Law to clarify the
due process protections afforded to a health care professional for
contract terminations also apply in instances of non-renewal. This
section also refines the process by which members of a hearing panel are
chosen to require that the panel be comprised of at least three NYS
licensed healthcare professionals, that one member is appointed by the
insurer, one is appointed by the subject of the hearing and that the
third panelist is chosen by the other two panel members.
Section 2 amends section 4803 of the Insurance Law to clarify the due
process protections afforded to a health care professional for contract
terminations. This section also refines the process by which members of
a hearing panel are chosen to require that the panel be comprised of at
least three NYS licensed healthcare professionals, that one member is
appointed by the insurer, one is appointed by the subject of the hearing
and that the third panelist is chosen by the other two panel members.
Section 3 provides the effective date.
 
JUSTIFICATION:
The relationship between a patient and his or her physician is integral
to the effective and efficient provision of quality health care
services. The better a physician knows a patient, knows the patient's
history, is aware of the patient's level of participation in improving
his or her own health and can meld these factors with the scientific
practice of medicine, the more likely the patient will receive the best
and most efficient health care.
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, in some instances 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 needed
specialists. This bill would extend these important statutory due proc-
ess protections, currently applicable to contract terminations, to
contract non-renewals to assure that such non-renewals occur for valid
reasons.
 
LEGISLATIVE HISTORY:
2013-2014: S5762 Hannon/A6498 Lavine
2015-2016: S4751 Hannon/A1212 Lavine
2017-2018: S3943 Hannon/A2704 Lavine
2019-2020: S3463 Rivera/A2835 Lavine
2021-2022: S2528 Rivera/A4177 Lavine
2023-2024: S3282-A Rivera/A1777-A Lavine
 
FISCAL IMPLICATIONS:S:
None.
 
EFFECTIVE DATE:
Effective Immediately.

Statutes affected:
S1911: 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