Assembly Bill A6426B

2013-2014 Legislative Session

Requires health care plans and insurers to provide expedited review of applications of health care professionals who are joining a group practice

download bill text pdf

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Archive: Last Bill Status - On Floor Calendar


  • Introduced
    • In Committee Assembly
    • In Committee Senate
    • On Floor Calendar Assembly
    • On Floor Calendar Senate
    • Passed Assembly
    • Passed Senate
  • Delivered to Governor
  • Signed By Governor

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Bill Amendments

2013-A6426 - Details

See Senate Version of this Bill:
S4970
Law Section:
Public Health Law
Laws Affected:
Amd §4406-d, Pub Health L; amd §4803, Ins L
Versions Introduced in 2015-2016 Legislative Session:
A501, S2545

2013-A6426 - Summary

Requires health care plans and insurers to provide expedited review of applications of health care professionals who are joining a group practice and grant provisional credentials to such professionals; provides that health care professionals who have received credentials and change the address of or add locations to the practice need only notify the health care plan or insurer of such change or addition.

2013-A6426 - Bill Text download pdf

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  6426

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                             March 26, 2013
                               ___________

Introduced by M. of A. CUSICK -- read once and referred to the Committee
  on Health

AN ACT to amend the public health law and the insurance law, in relation
  to  requiring  health  care  plans  and  insurers to provide expedited
  review of applications of health care professionals who are joining  a
  group practice and grant provisional credentials to such professionals

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1.  Subdivision 1 of section 4406-d of the public health  law,
as  amended  by  chapter  237 of the laws of 2009, is amended to read as
follows:
  1. (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  ninety  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  is  credentialed;
or  (ii) whether additional time is necessary to make a determination in
spite of the health care plan's best efforts or because of a failure  of
a  third  party  to  provide  necessary documentation, or non-routine or
unusual circumstances  require  additional  time  for  review.  In  such
instances where additional time is necessary because of a lack of neces-
sary documentation, a health plan shall make every effort to obtain such
information  as  soon as possible. PROVIDED, HOWEVER, THAT IF THE APPLI-
CANT IS A HEALTH CARE PROFESSIONAL WHO IS JOINING A  GROUP  PRACTICE  OF
HEALTH  CARE  PROFESSIONALS,  AT  LEAST  ONE OF WHOM PARTICIPATES IN THE

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD09628-01-3
              

2013-A6426A - Details

See Senate Version of this Bill:
S4970
Law Section:
Public Health Law
Laws Affected:
Amd §4406-d, Pub Health L; amd §4803, Ins L
Versions Introduced in 2015-2016 Legislative Session:
A501, S2545

2013-A6426A - Summary

Requires health care plans and insurers to provide expedited review of applications of health care professionals who are joining a group practice and grant provisional credentials to such professionals; provides that health care professionals who have received credentials and change the address of or add locations to the practice need only notify the health care plan or insurer of such change or addition.

2013-A6426A - Bill Text download pdf

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 6426--A

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                             March 26, 2013
                               ___________

Introduced by M. of A. CUSICK -- read once and referred to the Committee
  on Health -- recommitted to the Committee on Health in accordance with
  Assembly Rule 3, sec. 2 -- committee discharged, bill amended, ordered
  reprinted as amended and recommitted to said committee

AN ACT to amend the public health law and the insurance law, in relation
  to  requiring  health  care  plans  and  insurers to provide expedited
  review of applications of health care professionals who are joining  a
  group practice and grant provisional credentials to such professionals

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1.  Subdivision 1 of section 4406-d of the public health  law,
as  amended  by  chapter  237 of the laws of 2009, is amended to read as
follows:
  1. (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  ninety  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  is  credentialed;
or  (ii) whether additional time is necessary to make a determination in
spite of the health care plan's best efforts or because of a failure  of
a  third  party  to  provide  necessary documentation, or non-routine or
unusual circumstances  require  additional  time  for  review.  In  such
instances where additional time is necessary because of a lack of neces-
sary documentation, a health plan shall make every effort to obtain such
information  as  soon as possible. PROVIDED, HOWEVER, THAT IF THE APPLI-

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD09628-02-4
              

co-Sponsors

2013-A6426B (ACTIVE) - Details

See Senate Version of this Bill:
S4970
Law Section:
Public Health Law
Laws Affected:
Amd §4406-d, Pub Health L; amd §4803, Ins L
Versions Introduced in 2015-2016 Legislative Session:
A501, S2545

2013-A6426B (ACTIVE) - Summary

Requires health care plans and insurers to provide expedited review of applications of health care professionals who are joining a group practice and grant provisional credentials to such professionals; provides that health care professionals who have received credentials and change the address of or add locations to the practice need only notify the health care plan or insurer of such change or addition.

2013-A6426B (ACTIVE) - Bill Text download pdf

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 6426--B
                                                        Cal. No. 604

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                             March 26, 2013
                               ___________

Introduced by M. of A. CUSICK -- read once and referred to the Committee
  on Health -- recommitted to the Committee on Health in accordance with
  Assembly Rule 3, sec. 2 -- committee discharged, bill amended, ordered
  reprinted  as  amended  and  recommitted to said committee -- reported
  from committee, advanced to  a  third  reading,  amended  and  ordered
  reprinted, retaining its place on the order of third reading

AN ACT to amend the public health law and the insurance law, in relation
  to  requiring  health  care  plans  and  insurers to provide expedited
  review of applications of health care professionals who are joining  a
  group practice and grant provisional credentials to such professionals

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1.  Subdivision 1 of section 4406-d of the public health  law,
as  amended  by  chapter  237 of the laws of 2009, is amended to read as
follows:
  1. (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  ninety  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  is  credentialed;
or  (ii) whether additional time is necessary to make a determination in
spite of the health care plan's best efforts or because of a failure  of
a  third  party  to  provide  necessary documentation, or non-routine or
unusual circumstances  require  additional  time  for  review.  In  such
instances where additional time is necessary because of a lack of neces-

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
              

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