BILL NUMBER: S7913
SPONSOR: RIVERA
 
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:
Relates to improper practices relating to staff membership or profes-
sional privileges of a physician and such physician's board certif-
ication
 
SUMMARY OF SPECIFIC PROVISIONS:
Section 1 amends section 2801-b of the public health law as it relates
to improper practices of staff membership or professional privileges and
physician's board certification. This section prohibits the governing
body of a hospital to deny a physician staff membership or professional
privileges who was previously board-certified solely because such physi-
cian has not maintained such board certification.
Section 2 amends section 4406-d of the public health law as it relates
to minimum qualification requirements a healthcare professional must
meet in order to be considered for a healthcare plan. This section
prohibits an HMO from denying an application for participation in the
HMO's network to a physician who was previously board-certified solely
because such physicians have not maintained such board certification.
Section 3 of the bill amends section 4803 of the insurance law as it
relates to qualification requirements which a healthcare professional
must meet in order to be considered to participate in the in-network
portion of the insurance plan. This section prohibits 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 provides an effective date.
 
JUSTIFICATION:
The cost of obtaining and updating board certification status is
increasingly becoming prohibitively expensive and time-consuming 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 physicians 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 gener-
ally remain current in their knowledge base by attending seminars, read-
ing journals, discussions with other physicians, and various other
endeavors which are designed to continually improve a physician's deliv-
ery 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 increasingly prohibitively expensive.
For older physicians, the cost may drive them out of practicing medicine
altogether. This legislation would help to ensure that board certif-
ication remains aspirational for physicians, but not mandatory, by
ensuring that hospitals and health insurance companies cannot impose
such requirements as a condition of participation, thereby reducing one
barrier to delivering medical care in New York State.
 
LEGISLATIVE HISTORY:
2019-2020: S5280/A5140 Schimminger
2021-2022: S2116
2023-2024: S1727
 
FISCAL IMPLICATIONS:
None to the state
 
EFFECTIVE DATE:
This act shall take effect immediately.

Statutes affected:
S7913: 2801-b public health law, 2801-b(1) public health law, 4406-d public health law, 4406-d(1) public health law, 4803 insurance law, 4803(a) insurance law