S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1947
 
                        2017-2018 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 17, 2017
                                ___________
 
 Introduced  by  M.  of  A.  PRETLOW,  GOTTFRIED, CAHILL, COLTON, WEPRIN,
   MAGNARELLI, PERRY, JENNE, BRONSON, ROSENTHAL, LAVINE, THIELE, BENEDET-
   TO, TITONE, PEOPLES-STOKES, ABINANTI, ENGLEBRIGHT  --  Multi-Sponsored
   by  --  M.  of  A.  ABBATE,  AUBRY, COOK, CYMBROWITZ, DINOWITZ, GLICK,
   HIKIND, HOOPER, LENTOL, LOPEZ, LUPARDO, MAGEE, MALLIOTAKIS, MONTESANO,
   ORTIZ, RA, RAIA, WALTER, WRIGHT --  read  once  and  referred  to  the
   Committee on Health
 
 AN  ACT  to amend the public health law, in relation to requirements for
   collective negotiations by health care providers with  certain  health
   benefit  plans  in  certain  counties, and providing for the repeal of
   such provisions upon the expiration thereof
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Statement of legislative intent. The legislature finds that
 collective  negotiation by competing health care providers for the terms
 and conditions of contracts with health plans can result  in  beneficial
 results  for  health  care  consumers.  The  legislature  further  finds
 instances where health plans dominate the market to such a  degree  that
 fair  and  adequate  negotiations  between health care providers and the
 plans are adversely affected, so that it is necessary and appropriate to
 provide for a demonstration to examine the risks and benefits associated
 with a system of collective action on behalf of health  care  providers.
 Consequently,  the legislature finds it appropriate and necessary in the
 demonstration service area to displace competition  with  regulation  of
 health plan-provider agreements and authorize collective negotiations on
 the  terms  and conditions of the relationship between health care plans
 and health care providers so the imbalances between  the  two  will  not
 result in adverse conditions of health care. This act is not intended to
 apply  to  or  affect in any respect collective bargaining relationships
 involving health care providers as defined in section 4920 of the public

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD07786-02-7
              

 A. 1947                             2
 
 health law or rights relating to  collective  bargaining  arising  under
 applicable federal or state collective bargaining statutes.
   §  2.  This  act  shall  be known and may be cited as the "health care
 consumer and provider protection act".
   § 3. Article 49 of the public health law is amended by  adding  a  new
 title III to read as follows:
                                 TITLE III
                  COLLECTIVE NEGOTIATIONS BY HEALTH CARE
                     PROVIDERS WITH HEALTH CARE PLANS
 SECTION 4920. DEFINITIONS.
         4921. NON-FEE RELATED COLLECTIVE NEGOTIATION AUTHORIZED.
         4922. FEE RELATED COLLECTIVE NEGOTIATION.
         4923. COLLECTIVE NEGOTIATION REQUIREMENTS.
         4924. REQUIREMENTS FOR HEALTH CARE PROVIDERS' REPRESENTATIVE.
         4925. CERTAIN COLLECTIVE ACTION PROHIBITED.
         4926. FEES.
         4927. MONITORING OF AGREEMENTS.
         4928. CONFIDENTIALITY.
         4929. SEVERABILITY AND CONSTRUCTION.
   § 4920. DEFINITIONS. FOR PURPOSES OF THIS TITLE:
   1.  "HEALTH  CARE  PLAN"  MEANS  AN  ENTITY  (OTHER THAN A HEALTH CARE
 PROVIDER) THAT APPROVES, PROVIDES, ARRANGES FOR, OR PAYS FOR HEALTH CARE
 SERVICES IN THE DEMONSTRATION SERVICE AREA, INCLUDING  BUT  NOT  LIMITED
 TO:
   (A)  A  HEALTH  MAINTENANCE  ORGANIZATION LICENSED PURSUANT TO ARTICLE
 FORTY-THREE OF THE  INSURANCE  LAW  OR  CERTIFIED  PURSUANT  TO  ARTICLE
 FORTY-FOUR OF THIS CHAPTER;
   (B) ANY OTHER ORGANIZATION CERTIFIED PURSUANT TO ARTICLE FORTY-FOUR OF
 THIS CHAPTER; OR
   (C) AN INSURER OR CORPORATION SUBJECT TO THE INSURANCE LAW.
   2.  "PERSON"  MEANS  AN  INDIVIDUAL,  ASSOCIATION, CORPORATION, OR ANY
 OTHER LEGAL ENTITY.
   3. "HEALTH CARE PROVIDERS' REPRESENTATIVE" MEANS A THIRD PARTY WHO  IS
 AUTHORIZED  BY  HEALTH  CARE PROVIDERS TO NEGOTIATE ON THEIR BEHALF WITH
 HEALTH CARE PLANS OVER CONTRACTUAL TERMS AND CONDITIONS AFFECTING  THOSE
 HEALTH CARE PROVIDERS.
   4. "STRIKE" MEANS A WORK STOPPAGE IN PART OR IN WHOLE, DIRECT OR INDI-
 RECT,  BY  A  BODY OF WORKERS TO GAIN COMPLIANCE WITH DEMANDS MADE ON AN
 EMPLOYER.
   5. "SUBSTANTIAL MARKET SHARE IN A BUSINESS LINE" EXISTS  IF  A  HEALTH
 CARE  PLAN'S  MARKET  SHARE  OF A BUSINESS LINE WITHIN THE DEMONSTRATION
 SERVICE AREA AS APPROVED BY THE COMMISSIONER, IN CONSULTATION  WITH  THE
 SUPERINTENDENT  OF  FINANCIAL SERVICES, ALONE OR IN COMBINATION WITH THE
 MARKET SHARES OF AFFILIATES, EXCEEDS EITHER TEN  PERCENT  OF  THE  TOTAL
 NUMBER  OF  COVERED LIVES IN THAT SERVICE AREA FOR SUCH BUSINESS LINE OR
 TWENTY-FIVE THOUSAND LIVES, OR IF THE COMMISSIONER, IN CONSULTATION WITH
 THE SUPERINTENDENT OF FINANCIAL SERVICES, DETERMINES THE MARKET SHARE OF
 THE INSURER IN THE RELEVANT INSURANCE PRODUCT AND GEOGRAPHIC MARKETS FOR
 THE SERVICES OF THE PROVIDERS SEEKING TO COLLECTIVELY NEGOTIATE  SIGNIF-
 ICANTLY  EXCEEDS THE COUNTERVAILING MARKET SHARE OF THE PROVIDERS ACTING
 INDIVIDUALLY.
   6. "HEALTH CARE PROVIDER" MEANS A PERSON WHO IS  LICENSED,  CERTIFIED,
 OR REGISTERED PURSUANT TO TITLE EIGHT OF THE EDUCATION LAW AND WHO PRAC-
 TICES  AS A HEALTH CARE PROVIDER AS AN INDEPENDENT CONTRACTOR AND/OR WHO
 IS AN OWNER, OFFICER,  SHAREHOLDER,  OR  PROPRIETOR  OF  A  HEALTH  CARE
 PROVIDER  IN  THE  DEMONSTRATION  SERVICE AREA.   A HEALTH CARE PROVIDER

 A. 1947                             3

 UNDER TITLE EIGHT OF THE EDUCATION LAW WHO PRACTICES AS AN EMPLOYEE OF A
 HEALTH CARE PROVIDER SHALL NOT BE DEEMED  A  HEALTH  CARE  PROVIDER  FOR
 PURPOSES OF THIS TITLE.
   7.  "DEMONSTRATION SERVICE AREA" SHALL INCLUDE THE COUNTIES OF ALBANY,
 COLUMBIA, GREENE, ORANGE, RENSSELAER, SARATOGA, SCHENECTADY,  SCHOHARIE,
 ULSTER, WARREN AND WASHINGTON.
   §  4921.  NON-FEE RELATED COLLECTIVE NEGOTIATION AUTHORIZED. 1. HEALTH
 CARE PROVIDERS PRACTICING WITHIN THE DEMONSTRATION SERVICE AREA MAY MEET
 AND COMMUNICATE FOR THE  PURPOSE  OF  COLLECTIVELY  NEGOTIATING  WITH  A
 HEALTH  CARE  PLAN  THE  FOLLOWING  TERMS  AND  CONDITIONS  OF  PROVIDER
 CONTRACTS WITH THE HEALTH CARE PLAN:
   (A) THE DETAILS OF THE UTILIZATION REVIEW PLAN AS DEFINED PURSUANT  TO
 SUBDIVISION  TEN  OF  SECTION  FORTY-NINE  HUNDRED  OF  THIS ARTICLE AND
 SUBSECTION (J) OF SECTION FOUR THOUSAND NINE HUNDRED  OF  THE  INSURANCE
 LAW;
   (B)  COVERAGE  PROVISIONS;  HEALTH  CARE  BENEFITS;  BENEFIT MAXIMUMS,
 INCLUDING BENEFIT LIMITATIONS; AND EXCLUSIONS OF COVERAGE;
   (C) THE DEFINITION OF MEDICAL NECESSITY;
   (D) THE CLINICAL PRACTICE GUIDELINES USED TO  MAKE  MEDICAL  NECESSITY
 AND UTILIZATION REVIEW DETERMINATIONS;
   (E) PREVENTIVE CARE AND OTHER MEDICAL MANAGEMENT PRACTICES;
   (F)  DRUG  FORMULARIES  AND  STANDARDS  AND PROCEDURES FOR PRESCRIBING
 OFF-FORMULARY DRUGS;
   (G) RESPECTIVE PHYSICIAN LIABILITY FOR THE TREATMENT OR LACK OF TREAT-
 MENT OF COVERED PERSONS;
   (H) THE DETAILS OF HEALTH CARE PLAN RISK  TRANSFER  ARRANGEMENTS  WITH
 PROVIDERS;
   (I)  PLAN  ADMINISTRATIVE  PROCEDURES, INCLUDING METHODS AND TIMING OF
 HEALTH CARE PROVIDER PAYMENT FOR SERVICES;
   (J) PROCEDURES TO BE UTILIZED TO RESOLVE DISPUTES BETWEEN  THE  HEALTH
 CARE PLAN AND HEALTH CARE PROVIDERS;
   (K)  PATIENT  REFERRAL PROCEDURES INCLUDING, BUT NOT LIMITED TO, THOSE
 APPLICABLE TO OUT-OF-POCKET NETWORK REFERRALS;
   (L) THE FORMULATION AND APPLICATION OF HEALTH CARE PROVIDER REIMBURSE-
 MENT PROCEDURES;
   (M) QUALITY ASSURANCE PROGRAMS;
   (N)  THE  PROCESS  FOR  RENDERING  UTILIZATION  REVIEW  DETERMINATIONS
 INCLUDING:  ESTABLISHMENT  OF A PROCESS FOR RENDERING UTILIZATION REVIEW
 DETERMINATIONS WHICH SHALL, AT A MINIMUM, INCLUDE: WRITTEN PROCEDURES TO
 ASSURE THAT UTILIZATION REVIEWS AND DETERMINATIONS ARE CONDUCTED  WITHIN
 THE  TIMEFRAMES  ESTABLISHED  IN  THIS  ARTICLE; PROCEDURES TO NOTIFY AN
 ENROLLEE, AN  ENROLLEE'S  DESIGNEE  AND/OR  AN  ENROLLEE'S  HEALTH  CARE
 PROVIDER OF ADVERSE DETERMINATIONS; AND PROCEDURES FOR APPEAL OF ADVERSE
 DETERMINATIONS,  INCLUDING  THE  ESTABLISHMENT  OF  AN EXPEDITED APPEALS
 PROCESS FOR DENIALS OF CONTINUED INPATIENT CARE OR WHERE THERE IS  IMMI-
 NENT OR SERIOUS THREAT TO THE HEALTH OF THE ENROLLEE; AND
   (O)  HEALTH  CARE  PROVIDER SELECTION AND TERMINATION CRITERIA USED BY
 THE HEALTH CARE PLAN.
   2. NOTHING IN THIS SECTION SHALL BE CONSTRUED TO ALLOW OR AUTHORIZE AN
 ALTERATION OF THE TERMS OF THE INTERNAL AND EXTERNAL  REVIEW  PROCEDURES
 SET FORTH IN LAW.
   3.  NOTHING  IN THIS SECTION SHALL BE CONSTRUED TO ALLOW A STRIKE OF A
 HEALTH CARE PLAN BY HEALTH CARE PROVIDERS  OR  PLANS  AS  OTHERWISE  SET
 FORTH IN THE LAWS OF THIS STATE.
   4.  NOTHING  IN  THIS SECTION SHALL BE CONSTRUED TO ALLOW OR AUTHORIZE
 TERMS OR CONDITIONS WHICH WOULD IMPEDE THE ABILITY OF A HEALTH CARE PLAN

 A. 1947                             4
 
 TO OBTAIN OR RETAIN ACCREDITATION BY THE NATIONAL COMMITTEE FOR  QUALITY
 ASSURANCE OR A SIMILAR BODY.
   § 4922. FEE RELATED COLLECTIVE NEGOTIATION. 1. IF THE HEALTH CARE PLAN
 HAS  SUBSTANTIAL  MARKET  SHARE  IN A BUSINESS LINE IN THE DEMONSTRATION
 SERVICE AREA, HEALTH CARE PROVIDERS PRACTICING WITHIN THE  DEMONSTRATION
 SERVICE  AREA  MAY COLLECTIVELY NEGOTIATE THE FOLLOWING TERMS AND CONDI-
 TIONS RELATING TO THAT BUSINESS LINE WITH THE HEALTH CARE PLAN:
   (A) THE FEES ASSESSED BY THE HEALTH CARE PLAN FOR SERVICES,  INCLUDING
 FEES ESTABLISHED THROUGH THE APPLICATION OF REIMBURSEMENT PROCEDURES;
   (B)  THE  CONVERSION  FACTORS  USED  BY  THE  HEALTH  CARE  PLAN  IN A
 RESOURCE-BASED RELATIVE VALUE SCALE REIMBURSEMENT METHODOLOGY  OR  OTHER
 SIMILAR  METHODOLOGY; PROVIDED THE SAME ARE NOT OTHERWISE ESTABLISHED BY
 STATE OR FEDERAL LAW OR REGULATION;
   (C) THE AMOUNT OF ANY DISCOUNT GRANTED BY THE HEALTH CARE PLAN ON  THE
 FEE OF HEALTH CARE SERVICES TO BE RENDERED BY HEALTH CARE PROVIDERS;
   (D)  THE  DOLLAR  AMOUNT  OF  CAPITATION  OR  FIXED PAYMENT FOR HEALTH
 SERVICES RENDERED BY HEALTH CARE PROVIDERS TO HEALTH  CARE  PLAN  ENROL-
 LEES;
   (E)  THE  PROCEDURE CODE OR OTHER DESCRIPTION OF A HEALTH CARE SERVICE
 COVERED BY A PAYMENT AND  THE  APPROPRIATE  GROUPING  OF  THE  PROCEDURE
 CODES; OR
   (F) THE AMOUNT OF ANY OTHER COMPONENT OF THE REIMBURSEMENT METHODOLOGY
 FOR A HEALTH CARE SERVICE.
   2.  NOTHING  HEREIN  SHALL BE DEEMED TO AFFECT OR LIMIT THE RIGHT OF A
 HEALTH CARE PROVIDER OR GROUP OF HEALTH CARE PROVIDERS  TO  COLLECTIVELY
 PETITION A GOVERNMENT ENTITY FOR A CHANGE IN A LAW, RULE, OR REGULATION.
   § 4923. COLLECTIVE NEGOTIATION REQUIREMENTS. 1. COLLECTIVE NEGOTIATION
 RIGHTS GRANTED BY THIS TITLE MUST CONFORM TO THE FOLLOWING REQUIREMENTS:
   (A)  HEALTH  CARE  PROVIDERS  MAY  COMMUNICATE  WITH OTHER HEALTH CARE
 PROVIDERS REGARDING THE CONTRACTUAL TERMS AND CONDITIONS TO  BE  NEGOTI-
 ATED WITH A HEALTH CARE PLAN;
   (B)  HEALTH CARE PROVIDERS MAY COMMUNICATE WITH HEALTH CARE PROVIDERS'
 REPRESENTATIVES;
   (C) A HEALTH CARE PROVIDERS' REPRESENTATIVE IS THE ONLY PARTY  AUTHOR-
 IZED  TO  NEGOTIATE  WITH HEALTH CARE PLANS ON BEHALF OF THE HEALTH CARE
 PROVIDERS AS A GROUP;
   (D) A HEALTH CARE PROVIDER CAN BE BOUND BY THE  TERMS  AND  CONDITIONS
 NEGOTIATED BY THE HEALTH CARE PROVIDERS' REPRESENTATIVES; AND
   (E)  IN  COMMUNICATING  OR NEGOTIATING WITH THE HEALTH CARE PROVIDERS'
 REPRESENTATIVE, A HEALTH CARE PLAN IS ENTITLED TO CONTRACT WITH OR OFFER
 DIFFERENT CONTRACT TERMS AND CONDITIONS TO INDIVIDUAL  COMPETING  HEALTH
 CARE PROVIDERS.
   2. A HEALTH CARE PROVIDERS' REPRESENTATIVE MAY NOT REPRESENT MORE THAN
 THIRTY PERCENT OF THE MARKET OF HEALTH CARE PROVIDERS OR OF A PARTICULAR
 HEALTH  CARE  PROVIDER TYPE OR SPECIALTY PRACTICING IN THE DEMONSTRATION
 SERVICE AREA OR PROPOSED SERVICE AREA OF A HEALTH CARE PLAN THAT  COVERS
 LESS  THAN  FIVE  PERCENT  OF  THE ACTUAL NUMBER OF COVERED LIVES OF THE
 HEALTH CARE PLAN IN THE DEMONSTRATION SERVICE AREA, AS DETERMINED BY THE
 DEPARTMENT.
   3. NOTHING IN THIS SECTION SHALL BE CONSTRUED TO  PROHIBIT  COLLECTIVE
 ACTION  ON  THE  PART  OF  ANY HEALTH CARE PROVIDER WHO IS A MEMBER OF A
 COLLECTIVE BARGAINING UNIT RECOGNIZED PURSUANT  TO  THE  NATIONAL  LABOR
 RELATIONS ACT.
   §  4924.  REQUIREMENTS  FOR  HEALTH CARE PROVIDERS' REPRESENTATIVE. 1.
 BEFORE ENGAGING IN COLLECTIVE NEGOTIATIONS WITH A HEALTH  CARE  PLAN  ON
 BEHALF OF HEALTH CARE PROVIDERS, A HEALTH CARE PROVIDERS' REPRESENTATIVE

 A. 1947                             5
 
 SHALL  FILE  WITH  THE  COMMISSIONER,  IN  THE  MANNER PRESCRIBED BY THE
 COMMISSIONER, INFORMATION IDENTIFYING THE REPRESENTATIVE, THE  REPRESEN-
 TATIVE'S  PLAN  OF  OPERATION,  AND  THE  REPRESENTATIVE'S PROCEDURES TO
 ENSURE COMPLIANCE WITH THIS TITLE.
   2.  BEFORE  ENGAGING  IN  THE COLLECTIVE NEGOTIATIONS, THE HEALTH CARE
 PROVIDERS' REPRESENTATIVE SHALL ALSO SUBMIT TO THE COMMISSIONER FOR  THE
 COMMISSIONER'S APPROVAL A REPORT IDENTIFYING THE PROPOSED SUBJECT MATTER
 OF  THE  NEGOTIATIONS  OR  DISCUSSIONS WITH THE HEALTH CARE PLAN AND THE
 EFFICIENCIES OR BENEFITS EXPECTED TO BE  ACHIEVED  THROUGH  THE  NEGOTI-
 ATIONS  FOR  BOTH  THE  PROVIDERS  AND CONSUMERS OF HEALTH SERVICES. THE
 COMMISSIONER SHALL NOT  APPROVE  THE  REPORT  IF  THE  COMMISSIONER,  IN
 CONSULTATION  WITH  THE SUPERINTENDENT OF FINANCIAL SERVICES, DETERMINES
 THAT THE PROPOSED NEGOTIATIONS WOULD EXCEED THE AUTHORITY GRANTED  UNDER
 THIS TITLE.
   3.  THE  REPRESENTATIVE SHALL SUPPLEMENT THE INFORMATION IN THE REPORT
 ON A REGULAR BASIS OR AS NEW INFORMATION BECOMES  AVAILABLE,  INDICATING
 THAT  THE  SUBJECT  MATTER OF THE NEGOTIATIONS WITH THE HEALTH CARE PLAN
 HAS CHANGED OR WILL CHANGE. IN NO EVENT SHALL THE REPORT  BE  LESS  THAN
 EVERY THIRTY DAYS.
   4.  WITH  THE  ADVICE OF THE SUPERINTENDENT OF FINANCIAL SERVICES, THE
 COMMISSIONER SHALL APPROVE OR DISAPPROVE THE REPORT NOT LATER  THAN  THE
 TWENTIETH  DAY  AFTER  THE  DATE ON WHICH THE REPORT IS FILED. IF DISAP-
 PROVED, THE COMMISSIONER SHALL FURNISH  A  WRITTEN  EXPLANATION  OF  ANY
 DEFICIENCIES,  ALONG WITH A STATEMENT OF SPECIFIC PROPOSALS FOR REMEDIAL
 MEASURES TO CURE THE DEFICIENCIES. IF THE COMMISSIONER DOES NOT  SO  ACT
 WITHIN THE TWENTY DAYS, THE REPORT SHALL BE DEEMED APPROVED.
   5.  A PERSON WHO ACTS AS A HEALTH CARE PROVIDERS' REPRESENTATIVE WITH-
 OUT THE APPROVAL OF THE COMMISSIONER UNDER THIS SECTION SHALL BE  DEEMED
 TO BE ACTING OUTSIDE THE AUTHORITY GRANTED UNDER THIS TITLE.
   6.  BEFORE  REPORTING  THE  RESULTS OF NEGOTIATIONS WITH A HEALTH CARE
 PLAN OR PROVIDING TO THE AFFECTED HEALTH CARE PROVIDERS AN EVALUATION OF
 ANY OFFER MADE BY A HEALTH CARE PLAN, THE HEALTH CARE PROVIDERS'  REPRE-
 SENTATIVE SHALL FURNISH FOR APPROVAL BY THE COMMISSIONER, BEFORE DISSEM-
 INATION TO THE HEALTH CARE PROVIDERS, A COPY OF ALL COMMUNICATIONS TO BE
 MADE  TO THE HEALTH CARE PROVIDERS RELATED TO NEGOTIATIONS, DISCUSSIONS,
 AND OFFERS MADE BY THE HEALTH CARE PLAN.
   7. A HEALTH CARE PROVIDERS' REPRESENTATIVE   SHALL REPORT THE  END  OF
 NEGOTIATIONS TO THE COMMISSIONER NOT LATER THAN THE FOURTEENTH DAY AFTER
 THE DATE OF A HEALTH CARE PLAN DECISION DECLINING NEGOTIATION, CANCELING
 NEGOTIATIONS,  OR  FAILING  TO RESPOND TO A REQUEST FOR NEGOTIATION.  IN
 SUCH INSTANCES, A HEALTH  CARE  PROVIDERS'  REPRESENTATIVE  MAY  REQUEST
 INTERVENTION  FROM  THE  COMMISSIONER TO REQUIRE THE HEALTH CARE PLAN TO
 PARTICIPATE IN THE NEGOTIATION PURSUANT TO  SUBDIVISION  EIGHT  OF  THIS
 SECTION.
   8. (A) IN THE EVENT THE COMMISSIONER DETERMINES THAT AN IMPASSE EXISTS
 IN  THE  NEGOTIATIONS,  OR  IN  THE EVENT A HEALTH CARE PLAN DECLINES TO
 NEGOTIATE, CANCELS NEGOTIATIONS OR FAILS TO RESPOND  TO  A  REQUEST  FOR
 NEGOTIATION, THE COMMISSIONER SHALL RENDER ASSISTANCE AS FOLLOWS:
   (1)  TO  ASSIST  THE  PARTIES  TO EFFECT A VOLUNTARY RESOLUTION OF THE
 NEGOTIATIONS, THE COMMISSIONER SHALL APPOINT A MEDIATOR FROM A  LIST  OF
 QUALIFIED  PERSONS  MAINTAINED  BY  THE COMMISSIONER. IF THE MEDIATOR IS
 SUCCESSFUL IN RESOLVING THE IMPASSE, THEN  THE  HEALTH  CARE  PROVIDERS'
 REPRESENTATIVE SHALL PROCEED AS SET FORTH IN THIS ARTICLE;
   (2)  IF  AN  IMPASSE CONTINUES, THE COMMISSIONER SHALL APPOINT A FACT-
 FINDING BOARD OF NOT MORE THAN THREE MEMBERS FROM A  LIST  OF  QUALIFIED
 PERSONS  MAINTAINED  BY THE COMMISSIONER, WHICH FACT-FINDING BOARD SHALL

 A. 1947                             6
 
 HAVE, IN ADDITION TO THE POWERS DELEGATED TO IT BY THE BOARD, THE  POWER
 TO MAKE RECOMMENDATIONS FOR THE RESOLUTION OF THE DISPUTE;
   (B) THE FACT-FINDING BOARD, ACTING BY A MAJORITY OF ITS MEMBERS, SHALL
 TRANSMIT  ITS FINDINGS OF FACT AND RECOMMENDATIONS FOR RESOLUTION OF THE
 DISPUTE TO THE COMMISSIONER, AND MAY THEREAFTER ASSIST  THE  PARTIES  TO
 EFFECT  A  VOLUNTARY  RESOLUTION  OF THE DISPUTE. THE FACT-FINDING BOARD
 SHALL ALSO SHARE ITS FINDINGS  OF  FACT  AND  RECOMMENDATIONS  WITH  THE
 HEALTH CARE PROVIDERS' REPRESENTATIVE AND THE HEALTH CARE PLAN. IF WITH-
 IN  TWENTY  DAYS AFTER THE SUBMISSION OF THE FINDINGS OF FACT AND RECOM-
 MENDATIONS, THE IMPASSE CONTINUES, THE COMMISSIONER SHALL ORDER A RESOL-
 UTION  TO  THE  NEGOTIATIONS  BASED  UPON  THE  FINDINGS  OF  FACT   AND
 RECOMMENDATIONS SUBMITTED BY THE FACT-FINDING BOARD.
   9.  ANY  PROPOSED AGREEMENT BETWEEN HEALTH CARE PROVIDERS AND A HEALTH
 CARE PLAN NEGOTIATED PURSUANT TO THIS TITLE SHALL BE  SUBMITTED  TO  THE
 COMMISSIONER  FOR  FINAL  APPROVAL.  THE  COMMISSIONER  SHALL APPROVE OR
 DISAPPROVE THE AGREEMENT WITHIN SIXTY DAYS  OF  SUCH  SUBMISSION.    THE
 COMMISSIONER,  AFTER  CONSULTATION  WITH THE SUPERINTENDENT OF FINANCIAL
 SERVICES SHALL DISAPPROVE THE AGREEMENT IF HE  OR  SHE  FINDS  THAT  THE
 AGREEMENT  WOULD  RESULT IN A SIGNIFICANT INCREASE IN COSTS TO THE MEDI-
 CAID MANAGED CARE PROGRAM PURSUANT TO SECTION THREE HUNDRED SIXTY-FOUR-J
 OF THE SOCIAL SERVICES LAW, THE FAMILY HEALTH PLUS PROGRAM  PURSUANT  TO
 SECTION  THREE  HUNDRED SIXTY-NINE-GG OF THE SOCIAL SERVICES LAW, OR THE
 CHILD HEALTH PLUS PROGRAM PURSUANT TO SECTION TWENTY-FIVE HUNDRED ELEVEN
 OF THE PUBLIC HEALTH LAW.
   10. THE COMMISSIONER MAY COLLECT INFORMATION FROM  THE  DEPARTMENT  OF
 FINANCIAL  SERVICES AND OTHER PERSONS TO ASSIST IN EVALUATING THE IMPACT
 OF THE PROPOSED ARRANGEMENT ON THE HEALTH CARE MARKETPLACE. THE  COMMIS-
 SIONER  SHALL  COLLECT INFORMATION FROM HEALTH PLAN COMPANIES AND HEALTH
 CARE PROVIDERS OPERATING IN THE SAME GEOGRAPHIC AREA AS THE HEALTH  CARE
 COOPERATIVE.
   §  4925.  CERTAIN  COLLECTIVE  ACTION PROHIBITED. 1. THIS TITLE IS NOT
 INTENDED TO AUTHORIZE COMPETING HEALTH CARE PROVIDERS TO ACT IN  CONCERT
 IN  RESPONSE  TO A REPORT ISSUED BY THE HEALTH CARE PROVIDERS' REPRESEN-
 TATIVE RELATED TO THE REPRESENTATIVE'S DISCUSSIONS OR NEGOTIATIONS  WITH
 HEALTH CARE PLANS.
   2. NO HEALTH CARE PROVIDERS' REPRESENTATIVE SHALL NEGOTIATE ANY AGREE-
 MENT  THAT  EXCLUDES,  LIMITS  THE PARTICIPATION OR REIMBURSEMENT OF, OR
 OTHERWISE LIMITS THE SCOPE OF SERVICES TO BE PROVIDED BY ANY HEALTH CARE
 PROVIDER OR GROUP OF HEALTH CARE PROVIDERS WITH RESPECT TO THE  PERFORM-
 ANCE  OF  SERVICES  THAT  ARE WITHIN THE HEALTH CARE PROVIDER'S SCOPE OF
 PRACTICE, LICENSE, REGISTRATION, OR CERTIFICATE.
   § 4926. FEES. EACH PERSON WHO ACTS AS THE REPRESENTATIVE OR  NEGOTIAT-
 ING PARTIES UNDER THIS TITLE SHALL PAY TO THE DEPARTMENT A FEE TO ACT AS
 A  REPRESENTATIVE.  THE COMMISSIONER, BY RULE, SHALL SET FEES IN AMOUNTS
 DEEMED REASONABLE AND NECESSARY TO  COVER  THE  COSTS  INCURRED  BY  THE
 DEPARTMENT  IN  ADMINISTERING  THIS  TITLE. ANY FEE COLLECTED UNDER THIS
 SECTION SHALL BE DEPOSITED IN THE STATE TREASURY TO THE  CREDIT  OF  THE
 GENERAL  FUND/STATE  OPERATIONS  FOR  THE  NEW  YORK STATE DEPARTMENT OF
 HEALTH FUND.
   § 4927. MONITORING OF  AGREEMENTS.  THE  COMMISSIONER  SHALL  ACTIVELY
 MONITOR  AGREEMENTS  APPROVED UNDER THIS TITLE TO ENSURE THAT THE AGREE-
 MENT REMAINS  IN  COMPLIANCE  WITH  THE  CONDITIONS  OF  APPROVAL.  UPON
 REQUEST, A HEALTH CARE PLAN OR HEALTH CARE PROVIDER SHALL PROVIDE INFOR-
 MATION  REGARDING  COMPLIANCE.  THE  COMMISSIONER MAY REVOKE AN APPROVAL
 UPON A FINDING THAT THE AGREEMENT IS NOT IN SUBSTANTIAL COMPLIANCE  WITH
 THE TERMS OF THE APPLICATION OR THE CONDITIONS OF APPROVAL.

 A. 1947                             7
 
   § 4928. CONFIDENTIALITY. ALL REPORTS AND OTHER INFORMATION REQUIRED TO
 BE  REPORTED  TO  THE  DEPARTMENT UNDER THIS TITLE INCLUDING INFORMATION
 OBTAINED BY THE COMMISSIONER PURSUANT  TO  SUBDIVISION  TEN  OF  SECTION
 FORTY-NINE  HUNDRED  TWENTY-FOUR  OF  THIS TITLE SHALL NOT BE SUBJECT TO
 DISCLOSURE UNDER ARTICLE SIX OF THE PUBLIC OFFICERS LAW OR ARTICLE THIR-
 TY-ONE OF THE CIVIL PRACTICE LAW AND RULES.
   §  4929.  SEVERABILITY  AND CONSTRUCTION. THE PROVISIONS OF THIS TITLE
 SHALL BE SEVERABLE, AND IF ANY COURT OF COMPETENT JURISDICTION  DECLARES
 ANY  PHRASE,  CLAUSE, SENTENCE OR PROVISION OF THIS TITLE TO BE INVALID,
 OR ITS APPLICABILITY TO ANY GOVERNMENT, AGENCY, PERSON  OR  CIRCUMSTANCE
 IS DECLARED INVALID, THE REMAINDER OF THIS TITLE AND ITS RELEVANT APPLI-
 CABILITY  SHALL  NOT  BE AFFECTED. THE PROVISIONS OF THIS TITLE SHALL BE
 LIBERALLY CONSTRUED TO GIVE EFFECT TO THE PURPOSES THEREOF.
   § 4. The department of health, in consultation with the department  of
 financial  services,  shall prepare or shall arrange for the preparation
 of a report on  the  implementation  of  the  demonstration  program  on
 collective  negotiation.  The report shall be submitted to the governor,
 the speaker of the assembly, the temporary president of the  senate  and
 the chairs of the senate and assembly health and insurance committees at
 least  four months prior to the expiration of this act. The report shall
 review the extent to which collective negotiations were conducted in the
 demonstration service area and shall examine whether and the  extent  to
 which  collective  negotiation contributed to the improvement of quality
 of care for patients,  enhanced  access  to  medically  necessary  care,
 reduced  unnecessary  health care expenditures, and was otherwise in the
 public interest. The  report  may  make  recommendations  regarding  the
 extension,  alteration and/or expansion of these provisions and make any
 other recommendations related to the implementation of collective  nego-
 tiation pursuant to this act.
   § 5. This act shall take effect on the one hundred twentieth day after
 it shall have become a law and shall expire and be deemed repealed three
 years  after  it  shall  take  effect; provided that the commissioner of
 health is authorized to promulgate any and all rules and regulations and
 take any other measures necessary to implement this act on its effective
 date on or before such date.