Senate Bill S4783A

2015-2016 Legislative Session

Relates to the definition of a clinical peer reviewer

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Archive: Last Bill Status - In Senate Committee Insurance Committee


  • 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

2015-S4783 - Details

See Assembly Version of this Bill:
A445
Current Committee:
Senate Insurance
Law Section:
Insurance Law
Laws Affected:
Amd §4900, Ins L; amd §4900, Pub Health L
Versions Introduced in Other Legislative Sessions:
2009-2010: A723
2011-2012: A662
2013-2014: S6281, A2693
2017-2018: A2539
2019-2020: A3076
2021-2022: A879

2015-S4783 - Summary

Requires, for purposes of utilization review and external appeals, clinical peer reviewers to be licensed, registered or certified in this state and to be in the same specialty as the health care provider being reviewed.

2015-S4783 - Sponsor Memo

2015-S4783 - Bill Text download pdf

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

                                  4783

                       2015-2016 Regular Sessions

                            I N  S E N A T E

                             April 15, 2015
                               ___________

Introduced  by  Sen.  DeFRANCISCO -- 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 the definitions of "clinical peer reviewer"  for  the  purposes  of
  utilization review and external appeal

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

  Section 1.  Subsection (b) of section 4900 of the  insurance  law,  as
amended  by  chapter  586 of the laws of 1998, item (ii) of subparagraph
(B) of paragraph 1 as amended and subparagraph (C)  of  paragraph  1  as
added by chapter 41 of the laws of 2014, is amended to read as follows:
  (b) "Clinical peer reviewer" means:
  (1) for purposes of title one of this article:
  (A)  a  physician  who  possesses  a  current and valid non-restricted
license to practice medicine PURSUANT TO ARTICLE ONE HUNDRED  THIRTY-ONE
OF THE EDUCATION LAW; or
  (B) a health care professional other than a licensed physician who:
  (i)  where  applicable,  possesses  a current and valid non-restricted
license, certificate or registration  [or,  where  no  provision  for  a
license,  certificate  or  registration  exists,  is credentialed by the
national accrediting body appropriate to the profession] ISSUED PURSUANT
TO TITLE EIGHT OF THE EDUCATION LAW; and
  (ii) is in the same profession and same or similar  specialty  as  the
health  care  provider  who  typically  manages the medical condition or
disease or provides the health care service or treatment  under  review;
or
  (C)  for  purposes of a determination involving substance use disorder
treatment:
  (i) a physician who  possesses  a  current  and  valid  non-restricted
license  to  practice  medicine and who specializes in behavioral health

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD10479-01-5

              

2015-S4783A (ACTIVE) - Details

See Assembly Version of this Bill:
A445
Current Committee:
Senate Insurance
Law Section:
Insurance Law
Laws Affected:
Amd §4900, Ins L; amd §4900, Pub Health L
Versions Introduced in Other Legislative Sessions:
2009-2010: A723
2011-2012: A662
2013-2014: S6281, A2693
2017-2018: A2539
2019-2020: A3076
2021-2022: A879

2015-S4783A (ACTIVE) - Summary

Requires, for purposes of utilization review and external appeals, clinical peer reviewers to be licensed, registered or certified in this state and to be in the same specialty as the health care provider being reviewed.

2015-S4783A (ACTIVE) - Sponsor Memo

2015-S4783A (ACTIVE) - Bill Text download pdf

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

                                 4783--A

                       2015-2016 Regular Sessions

                            I N  S E N A T E

                             April 15, 2015
                               ___________

Introduced  by  Sen.  DeFRANCISCO -- read twice and ordered printed, and
  when printed to be committed to the Committee on Insurance --  commit-
  tee  discharged, bill amended, ordered reprinted as amended and recom-
  mitted to said committee

AN ACT to amend the public health law and the insurance law, in relation
  to the definition of clinical peer reviewer

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

  Section  1. Subdivision 2 of section 4900 of the public health law, as
amended by chapter 586 of the laws of 1998,  item  (B)  of  subparagraph
(ii) of paragraph (a) as amended and subparagraph (iii) of paragraph (a)
as  added  by  chapter  41  of  the  laws of 2014, is amended to read as
follows:
  2. "Clinical peer reviewer" means:
  (a) [for purposes of title one of this article:
  (i) a physician who  possesses  a  current  and  valid  non-restricted
license to practice medicine; or
  (ii) a health care professional other than a licensed physician who:
  (A)  where  applicable,  possesses  a current and valid non-restricted
license, certificate or  registration  or,  where  no  provision  for  a
license,  certificate  or  registration  exists,  is credentialed by the
national accrediting body appropriate to the profession; and
  (B) is in the same profession and same or  similar  specialty  as  the
health  care  provider  who  typically  manages the medical condition or
disease or provides the health care service or treatment  under  review;
or
  (iii) for purposes of a determination involving substance use disorder
treatment:
  (A)  a  physician  who  possesses  a  current and valid non-restricted
license to practice medicine and who specializes  in  behavioral  health

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD10479-02-5

              

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