Bill S4476-2013

Restricts limitations on non-affiliated physicians from becoming a network provider of any health care plan or health maintenance organization

Provides that no insurer or health care plan shall by contract, written policy or written procedure require the maintenance of hospital privileges by any non-hospital employee health care provider as a condition of entering into or maintaining a contract, agreement of membership or acceptance into a health care plan or health maintenance organization's provider network; provides that no insurer or health care plan can prohibit or restrict any health care provider from referring an insured to another physician based solely upon the referred physician's lack of affiliation and/or lack of hospital privileges.

Details

Actions

  • Apr 15, 2013: RECOMMIT, ENACTING CLAUSE STRICKEN
  • Apr 3, 2013: REFERRED TO INSURANCE

Memo

BILL NUMBER:S4476

TITLE OF BILL: An act to amend the insurance law and the public health law, in relation to restricting limitations on non-affiliated physicians from becoming a network provider of any health care plan or health maintenance organization

PURPOSE:

To allow non-affiliated physicians the opportunity to be part of a health insurer's provider network in order to coordinate patient care and help control the spiraling cost of medical care.

SUMMARY OF PROVISIONS:

Amends section 3217-b of the insurance law and section 4406-c of the public health law to prohibit a health insurer from requiring a physician to be affiliated with and/or maintain hospital privileges as a condition of entering into or remaining in the provider network. Also prohibits a health insurer from restricting a physician's ability to refer a patient to another physician based solely on the referred physician's lack of affiliation with a hospital.

JUSTIFICATION:

The contractual agreements that exist between insurance companies and hospitals creates an environment that restricts community based physicians from entering into network provider agreements unless they are unaffiliated with a hospital. This practice is unfair if the non-affiliated health care provider meets the credentialing standards The health care provider is responsible for meeting the requirements for participation. Upon meeting the necessary criteria for qualification, there should be no basis for denial of the non-affiliated independent physician's right to become a network provider of any New York State sanctioned health care plan and/or health maintenance organization.

LEGISLATIVE HISTORY:

S 7336 of 2012

FISCAL IMPLICATIONS:

None.

EFFECTIVE DATE:

180 days after becoming a law.


Text

STATE OF NEW YORK ________________________________________________________________________ 4476 2013-2014 Regular Sessions IN SENATE April 3, 2013 ___________
Introduced by Sen. SEWARD -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance AN ACT to amend the insurance law and the public health law, in relation to restricting limitations on non-affiliated physicians from becoming a network provider of any health care plan or health maintenance organization THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Section 3217-b of the insurance law is amended by adding a new subsection (k) to read as follows: (K) (1) NO INSURER SUBJECT TO THIS ARTICLE SHALL BY CONTRACT, WRITTEN POLICY OR WRITTEN PROCEDURE REQUIRE THE AFFILIATION AND/OR REQUIRE THE MAINTENANCE OF HOSPITAL PRIVILEGES BY ANY NON-HOSPITAL EMPLOYEE HEALTH CARE PROVIDER AS A CONDITION OF ENTERING INTO AND/OR MAINTAINING A CONTRACT, AGREEMENT OF MEMBERSHIP OR ACCEPTANCE INTO A HEALTH CARE PLAN OR HEALTH MAINTENANCE ORGANIZATION'S PROVIDER NETWORK. (2) NO INSURER SUBJECT TO THIS ARTICLE SHALL BY CONTRACT, WRITTEN POLICY OR WRITTEN PROCEDURE PROHIBIT OR RESTRICT ANY HEALTH CARE PROVID- ER FROM REFERRING AN INSURED TO ANOTHER PHYSICIAN BASED SOLELY UPON THE REFERRED PHYSICIAN'S LACK OF AFFILIATION AND/OR LACK OF HOSPITAL PRIVI- LEGES; PROVIDED THAT THE REFERRED PHYSICIAN IS LICENSED TO PRACTICE UNDER APPLICABLE STATE LAW. S 2. Subdivision 7 of section 4406-c of the public health law, as renumbered by section 487 of the laws of 2010, is renumbered subdivision 10 and a new subdivision 9 is added to read as follows: 9. (A) NO HEALTH CARE PLAN SHALL BY CONTRACT, WRITTEN POLICY OR WRIT- TEN PROCEDURE REQUIRE THE AFFILIATION AND/OR REQUIRE THE MAINTENANCE OF HOSPITAL PRIVILEGES BY ANY NON-HOSPITAL EMPLOYEE HEALTH CARE PROVIDER AS A CONDITION OF ENTERING INTO AND/OR MAINTAINING A CONTRACT, AGREEMENT OF MEMBERSHIP OR ACCEPTANCE INTO A HEALTH CARE PLAN OR HEALTH MAINTENANCE ORGANIZATION'S PROVIDER NETWORK.
(B) NO HEALTH CARE PLAN SHALL BY CONTRACT, WRITTEN POLICY OR WRITTEN PROCEDURE PROHIBIT OR RESTRICT ANY HEALTH CARE PROVIDER FROM REFERRING AN INSURED TO ANOTHER PHYSICIAN BASED SOLELY UPON THE REFERRED PHYSI- CIAN'S LACK OF AFFILIATION AND/OR LACK OF HOSPITAL PRIVILEGES; PROVIDED THAT THE REFERRED PHYSICIAN IS LICENSED TO PRACTICE UNDER APPLICABLE STATE LAW. S 3. This act shall take effect on the one hundred eightieth day after it shall have become a law.

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