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A05692 Summary:

BILL NO    A05692 

SAME AS    SAME AS S03690

SPONSOR    Gottfried (MS)

COSPNSR    Cahill, Colton, Magnarelli, Galef, Paulin, Schimel, Lifton, Cusick,
           O'Donnell, Jaffee, Weisenberg, Perry, Russell, Markey, Bronson,
           Rosenthal, Kellner, Lavine, Thiele, Benedetto, Titone,
           Peoples-Stokes, Gunther, Weprin, Abinanti, Englebright, Roberts,
           Brook-Krasny, Robinson, Skoufis, Otis, Aubry, Wright

MLTSPNSR   Abbate, Arroyo, Brennan, Buchwald, Cook, Cymbrowitz, Dinowitz, Fahy,
           Glick, Heastie, Hikind, Hooper, Jacobs, Lentol, Lupardo, Magee,
           Malliotakis, McDonald, Millman, Montesano, Moya, Ortiz, Pretlow,
           Raia, Scarborough, Sepulveda, Sweeney, Weinstein

Add Art 49 Title III SS4920 - 4929, Pub Health L

Enacts provisions relating to collective negotiations by health care providers
with certain health care plans in certain counties; applies to health benefit
plans that provide benefits for medical or surgical expenses incurred as a
result of a health condition, accident or sickness, including an individual,
group, blanket or franchise insurance policy or insurance agreement offered by
certain enumerated entities.
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A05692 Text:

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

                                         5692

                              2013-2014 Regular Sessions

                                 I N  A S S E M B L Y

                                     March 5, 2013
                                      ___________

       Introduced  by  M.  of  A. GOTTFRIED, CAHILL, COLTON, MAGNARELLI, GALEF,
         PAULIN, SCHIMEL, LIFTON, CUSICK, O'DONNELL, JAFFEE, WEISENBERG, PERRY,
         RUSSELL, MARKEY, BRONSON, ROSENTHAL, KELLNER, LAVINE, THIELE, BENEDET-
         TO, TITONE, BOYLAND, PEOPLES-STOKES, GUNTHER, WEPRIN, ABINANTI, ENGLE-
         BRIGHT, ROBERTS, MAISEL, BROOK-KRASNY, STEVENSON -- Multi-Sponsored by
         -- M. of A. ABBATE, ARROYO, AUBRY, BRENNAN, COOK,  CYMBROWITZ,  DINOW-
         ITZ,  FAHY,  GLICK, HEASTIE, HIKIND, HOOPER, JACOBS, LENTOL, V. LOPEZ,
         LOSQUADRO, LUPARDO, MAGEE, MALLIOTAKIS, McDONALD, MILLMAN,  MONTESANO,
         ORTIZ,  PRETLOW, RAIA, SCARBOROUGH, SWEENEY, WEINSTEIN, 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

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

    1    Section 1. Statement of legislative intent. The legislature finds that
    2  collective  negotiation by competing health care providers for the terms
    3  and conditions of contracts with health plans can result  in  beneficial
    4  results  for  health  care  consumers.  The  legislature  further  finds
    5  instances where health plans dominate the market to such a  degree  that
    6  fair  and  adequate  negotiations  between health care providers and the
    7  plans are adversely affected, so that it is necessary and appropriate to
    8  provide for a system of collective  action  on  behalf  of  health  care
    9  providers. Consequently, the legislature finds it appropriate and neces-
   10  sary  to  displace  competition  with regulation of health plan-provider
   11  agreements and authorize collective negotiations on the terms and condi-
   12  tions of the relationship between health  care  plans  and  health  care
   13  providers  so  the imbalances between the two will not result in adverse
   14  conditions of health care. This act is  not  intended  to  apply  to  or
   15  affect  in  any  respect collective bargaining relationships which arise
   16  under applicable federal or state collective bargaining statutes.

        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD08691-01-3
       A. 5692                             2

    1    S 2. This act shall be known and may be  cited  as  the  "health  care
    2  consumer and provider protection act".
    3    S  3.  Article  49 of the public health law is amended by adding a new
    4  title III to read as follows:
    5                                  TITLE III
    6                   COLLECTIVE NEGOTIATIONS BY HEALTH CARE
    7                      PROVIDERS WITH HEALTH CARE PLANS
    8  SECTION 4920. DEFINITIONS.
    9          4921. NON-FEE RELATED COLLECTIVE NEGOTIATION AUTHORIZED.
   10          4922. FEE RELATED COLLECTIVE NEGOTIATION.
   11          4923. COLLECTIVE NEGOTIATION REQUIREMENTS.
   12          4924. REQUIREMENTS FOR HEALTH CARE PROVIDERS' REPRESENTATIVE.
   13          4925. CERTAIN COLLECTIVE ACTION PROHIBITED.
   14          4926. FEES.
   15          4927. MONITORING OF AGREEMENTS.
   16          4928. CONFIDENTIALITY.
   17          4929. SEVERABILITY AND CONSTRUCTION.
   18    S 4920. DEFINITIONS. FOR PURPOSES OF THIS TITLE:
   19    1. "HEALTH CARE PLAN" MEANS  AN  ENTITY  (OTHER  THAN  A  HEALTH  CARE
   20  PROVIDER) THAT APPROVES, PROVIDES, ARRANGES FOR, OR PAYS FOR HEALTH CARE
   21  SERVICES, INCLUDING BUT NOT LIMITED TO:
   22    (A)  A  HEALTH  MAINTENANCE  ORGANIZATION LICENSED PURSUANT TO ARTICLE
   23  FORTY-THREE OF THE  INSURANCE  LAW  OR  CERTIFIED  PURSUANT  TO  ARTICLE
   24  FORTY-FOUR OF THIS CHAPTER;
   25    (B) ANY OTHER ORGANIZATION CERTIFIED PURSUANT TO ARTICLE FORTY-FOUR OF
   26  THIS CHAPTER; OR
   27    (C) AN INSURER OR CORPORATION SUBJECT TO THE INSURANCE LAW.
   28    2.  "PERSON"  MEANS  AN  INDIVIDUAL,  ASSOCIATION, CORPORATION, OR ANY
   29  OTHER LEGAL ENTITY.
   30    3. "HEALTH CARE PROVIDERS' REPRESENTATIVE" MEANS A THIRD PARTY WHO  IS
   31  AUTHORIZED  BY  HEALTH  CARE PROVIDERS TO NEGOTIATE ON THEIR BEHALF WITH
   32  HEALTH CARE PLANS OVER CONTRACTUAL TERMS AND CONDITIONS AFFECTING  THOSE
   33  HEALTH CARE PROVIDERS.
   34    4. "STRIKE" MEANS A WORK STOPPAGE IN PART OR IN WHOLE, DIRECT OR INDI-
   35  RECT, BY A HEALTH CARE PROVIDER OR HEALTH CARE PROVIDERS TO GAIN COMPLI-
   36  ANCE WITH DEMANDS MADE ON A HEALTH CARE PLAN.
   37    5.  "SUBSTANTIAL  MARKET  SHARE IN A BUSINESS LINE" EXISTS IF A HEALTH
   38  CARE PLAN'S MARKET SHARE OF A BUSINESS LINE WITHIN THE  GEOGRAPHIC  AREA
   39  FOR  WHICH A NEGOTIATION HAS BEEN APPROVED BY THE COMMISSIONER, ALONE OR
   40  IN COMBINATION WITH THE MARKET SHARES OF AFFILIATES, EXCEEDS EITHER  TEN
   41  PERCENT  OF  THE  TOTAL NUMBER OF COVERED LIVES IN THAT SERVICE AREA FOR
   42  SUCH BUSINESS LINE OR TWENTY-FIVE THOUSAND LIVES, OR IF THE COMMISSIONER
   43  DETERMINES THE MARKET SHARE OF THE INSURER  IN  THE  RELEVANT  INSURANCE
   44  PRODUCT AND GEOGRAPHIC MARKETS FOR THE SERVICES OF THE PROVIDERS SEEKING
   45  TO  COLLECTIVELY  NEGOTIATE  SIGNIFICANTLY  EXCEEDS  THE  COUNTERVAILING
   46  MARKET SHARE OF THE PROVIDERS ACTING INDIVIDUALLY.
   47    6. "HEALTH CARE PROVIDER" MEANS A PERSON WHO IS  LICENSED,  CERTIFIED,
   48  OR REGISTERED PURSUANT TO TITLE EIGHT OF THE EDUCATION LAW AND WHO PRAC-
   49  TICES  AS A HEALTH CARE PROVIDER AS AN INDEPENDENT CONTRACTOR AND/OR WHO
   50  IS AN OWNER, OFFICER,  SHAREHOLDER,  OR  PROPRIETOR  OF  A  HEALTH  CARE
   51  PROVIDER.  A HEALTH CARE PROVIDER UNDER TITLE EIGHT OF THE EDUCATION LAW
   52  WHO PRACTICES AS AN EMPLOYEE OF A HEALTH  CARE  PROVIDER  SHALL  NOT  BE
   53  DEEMED A HEALTH CARE PROVIDER FOR PURPOSES OF THIS TITLE.
   54    S  4921.  NON-FEE RELATED COLLECTIVE NEGOTIATION AUTHORIZED. 1. HEALTH
   55  CARE PROVIDERS PRACTICING WITHIN THE GEOGRAPHIC AREA FOR WHICH A NEGOTI-
   56  ATION HAS BEEN APPROVED BY THE COMMISSIONER MAY MEET AND COMMUNICATE FOR
       A. 5692                             3

    1  THE PURPOSE OF COLLECTIVELY NEGOTIATING THE FOLLOWING TERMS  AND  CONDI-
    2  TIONS OF PROVIDER CONTRACTS WITH THE HEALTH CARE PLAN:
    3    (A)  THE DETAILS OF THE UTILIZATION REVIEW PLAN AS DEFINED PURSUANT TO
    4  SUBDIVISION TEN OF  SECTION  FORTY-NINE  HUNDRED  OF  THIS  ARTICLE  AND
    5  SUBSECTION  (J)  OF  SECTION FOUR THOUSAND NINE HUNDRED OF THE INSURANCE
    6  LAW;
    7    (B) COVERAGE  PROVISIONS;  HEALTH  CARE  BENEFITS;  BENEFIT  MAXIMUMS,
    8  INCLUDING BENEFIT LIMITATIONS; AND EXCLUSIONS OF COVERAGE;
    9    (C) THE DEFINITION OF MEDICAL NECESSITY;
   10    (D)  THE  CLINICAL  PRACTICE GUIDELINES USED TO MAKE MEDICAL NECESSITY
   11  AND UTILIZATION REVIEW DETERMINATIONS;
   12    (E) PREVENTIVE CARE AND OTHER MEDICAL MANAGEMENT PRACTICES;
   13    (F) DRUG FORMULARIES AND  STANDARDS  AND  PROCEDURES  FOR  PRESCRIBING
   14  OFF-FORMULARY DRUGS;
   15    (G) RESPECTIVE PHYSICIAN LIABILITY FOR THE TREATMENT OR LACK OF TREAT-
   16  MENT OF COVERED PERSONS;
   17    (H)  THE  DETAILS  OF HEALTH CARE PLAN RISK TRANSFER ARRANGEMENTS WITH
   18  PROVIDERS;
   19    (I) PLAN ADMINISTRATIVE PROCEDURES, INCLUDING METHODS  AND  TIMING  OF
   20  HEALTH CARE PROVIDER PAYMENT FOR SERVICES;
   21    (J)  PROCEDURES  TO BE UTILIZED TO RESOLVE DISPUTES BETWEEN THE HEALTH
   22  CARE PLAN AND HEALTH CARE PROVIDERS;
   23    (K) PATIENT REFERRAL PROCEDURES INCLUDING, BUT NOT LIMITED  TO,  THOSE
   24  APPLICABLE TO OUT-OF-NETWORK REFERRALS;
   25    (L) THE FORMULATION AND APPLICATION OF HEALTH CARE PROVIDER REIMBURSE-
   26  MENT PROCEDURES;
   27    (M) QUALITY ASSURANCE PROGRAMS;
   28    (N)  THE  PROCESS  FOR  RENDERING  UTILIZATION  REVIEW  DETERMINATIONS
   29  INCLUDING: ESTABLISHMENT OF A PROCESS FOR RENDERING  UTILIZATION  REVIEW
   30  DETERMINATIONS WHICH SHALL, AT A MINIMUM, INCLUDE: WRITTEN PROCEDURES TO
   31  ASSURE  THAT UTILIZATION REVIEWS AND DETERMINATIONS ARE CONDUCTED WITHIN
   32  THE TIMEFRAMES ESTABLISHED IN THIS  ARTICLE;  PROCEDURES  TO  NOTIFY  AN
   33  ENROLLEE,  AN  ENROLLEE'S  DESIGNEE  AND/OR  AN  ENROLLEE'S  HEALTH CARE
   34  PROVIDER OF ADVERSE DETERMINATIONS; AND PROCEDURES FOR APPEAL OF ADVERSE
   35  DETERMINATIONS, INCLUDING THE  ESTABLISHMENT  OF  AN  EXPEDITED  APPEALS
   36  PROCESS  FOR DENIALS OF CONTINUED INPATIENT CARE OR WHERE THERE IS IMMI-
   37  NENT OR SERIOUS THREAT TO THE HEALTH OF THE ENROLLEE; AND
   38    (O) HEALTH CARE PROVIDER SELECTION AND TERMINATION  CRITERIA  USED  BY
   39  THE HEALTH CARE PLAN.
   40    2. NOTHING IN THIS SECTION SHALL BE CONSTRUED TO ALLOW OR AUTHORIZE AN
   41  ALTERATION  OF  THE TERMS OF THE INTERNAL AND EXTERNAL REVIEW PROCEDURES
   42  SET FORTH IN LAW.
   43    3. NOTHING IN THIS SECTION SHALL BE CONSTRUED TO ALLOW A STRIKE  OF  A
   44  HEALTH  CARE  PLAN  BY  HEALTH  CARE PROVIDERS OR PLANS AS OTHERWISE SET
   45  FORTH IN THE LAWS OF THIS STATE.
   46    4. NOTHING IN THIS SECTION SHALL BE CONSTRUED TO  ALLOW  OR  AUTHORIZE
   47  TERMS OR CONDITIONS WHICH WOULD IMPEDE THE ABILITY OF A HEALTH CARE PLAN
   48  TO  OBTAIN OR RETAIN ACCREDITATION BY THE NATIONAL COMMITTEE FOR QUALITY
   49  ASSURANCE OR A SIMILAR BODY.
   50    S 4922. FEE RELATED COLLECTIVE NEGOTIATION. 1. IF THE HEALTH CARE PLAN
   51  HAS SUBSTANTIAL MARKET SHARE IN A BUSINESS LINE IN ANY  GEOGRAPHIC  AREA
   52  FOR  WHICH  A  NEGOTIATION HAS BEEN APPROVED BY THE COMMISSIONER, HEALTH
   53  CARE PROVIDERS PRACTICING WITHIN THAT GEOGRAPHIC AREA  MAY  COLLECTIVELY
   54  NEGOTIATE  THE  FOLLOWING TERMS AND CONDITIONS RELATING TO THAT BUSINESS
   55  LINE WITH THE HEALTH CARE PLAN:
       A. 5692                             4

    1    (A) THE FEES ASSESSED BY THE HEALTH CARE PLAN FOR SERVICES,  INCLUDING
    2  FEES ESTABLISHED THROUGH THE APPLICATION OF REIMBURSEMENT PROCEDURES;
    3    (B)  THE  CONVERSION  FACTORS  USED  BY  THE  HEALTH  CARE  PLAN  IN A
    4  RESOURCE-BASED RELATIVE VALUE SCALE REIMBURSEMENT METHODOLOGY  OR  OTHER
    5  SIMILAR  METHODOLOGY; PROVIDED THE SAME ARE NOT OTHERWISE ESTABLISHED BY
    6  STATE OR FEDERAL LAW OR REGULATION;
    7    (C) THE AMOUNT OF ANY DISCOUNT GRANTED BY THE HEALTH CARE PLAN ON  THE
    8  FEE OF HEALTH CARE SERVICES TO BE RENDERED BY HEALTH CARE PROVIDERS;
    9    (D)  THE  DOLLAR  AMOUNT  OF  CAPITATION  OR  FIXED PAYMENT FOR HEALTH
   10  SERVICES RENDERED BY HEALTH CARE PROVIDERS TO HEALTH  CARE  PLAN  ENROL-
   11  LEES;
   12    (E)  THE  PROCEDURE CODE OR OTHER DESCRIPTION OF A HEALTH CARE SERVICE
   13  COVERED BY A PAYMENT AND  THE  APPROPRIATE  GROUPING  OF  THE  PROCEDURE
   14  CODES; OR
   15    (F) THE AMOUNT OF ANY OTHER COMPONENT OF THE REIMBURSEMENT METHODOLOGY
   16  FOR A HEALTH CARE SERVICE.
   17    2.  NOTHING  HEREIN  SHALL BE DEEMED TO AFFECT OR LIMIT THE RIGHT OF A
   18  HEALTH CARE PROVIDER OR GROUP OF HEALTH CARE PROVIDERS  TO  COLLECTIVELY
   19  PETITION A GOVERNMENT ENTITY FOR A CHANGE IN A LAW, RULE, OR REGULATION.
   20    S 4923. COLLECTIVE NEGOTIATION REQUIREMENTS. 1. COLLECTIVE NEGOTIATION
   21  RIGHTS GRANTED BY THIS TITLE MUST CONFORM TO THE FOLLOWING REQUIREMENTS:
   22    (A)  HEALTH  CARE  PROVIDERS  MAY  COMMUNICATE  WITH OTHER HEALTH CARE
   23  PROVIDERS REGARDING THE CONTRACTUAL TERMS AND CONDITIONS TO  BE  NEGOTI-
   24  ATED WITH A HEALTH CARE PLAN;
   25    (B)  HEALTH CARE PROVIDERS MAY COMMUNICATE WITH HEALTH CARE PROVIDERS'
   26  REPRESENTATIVES;
   27    (C) A HEALTH CARE PROVIDERS' REPRESENTATIVE IS THE ONLY PARTY  AUTHOR-
   28  IZED  TO  NEGOTIATE  WITH HEALTH CARE PLANS ON BEHALF OF THE HEALTH CARE
   29  PROVIDERS AS A GROUP;
   30    (D) A HEALTH CARE PROVIDER CAN BE BOUND BY THE  TERMS  AND  CONDITIONS
   31  NEGOTIATED BY THE HEALTH CARE PROVIDERS' REPRESENTATIVES; AND
   32    (E)  IN  COMMUNICATING  OR NEGOTIATING WITH THE HEALTH CARE PROVIDERS'
   33  REPRESENTATIVE, A HEALTH CARE PLAN IS ENTITLED TO CONTRACT WITH OR OFFER
   34  DIFFERENT CONTRACT TERMS AND CONDITIONS TO INDIVIDUAL  COMPETING  HEALTH
   35  CARE PROVIDERS.
   36    2. A HEALTH CARE PROVIDERS' REPRESENTATIVE MAY NOT REPRESENT MORE THAN
   37  THIRTY PERCENT OF THE MARKET OF HEALTH CARE PROVIDERS OR OF A PARTICULAR
   38  HEALTH CARE PROVIDER TYPE OR SPECIALTY PRACTICING IN THE GEOGRAPHIC AREA
   39  FOR  WHICH  A  NEGOTIATION  HAS BEEN APPROVED BY THE COMMISSIONER IF THE
   40  HEALTH CARE PLAN COVERS LESS THAN FIVE PERCENT OF THE ACTUAL  NUMBER  OF
   41  COVERED  LIVES OF THE HEALTH CARE PLAN IN THE AREA, AS DETERMINED BY THE
   42  DEPARTMENT.
   43    3. NOTHING IN THIS SECTION SHALL BE CONSTRUED TO  PROHIBIT  COLLECTIVE
   44  ACTION  ON  THE  PART  OF  ANY HEALTH CARE PROVIDER WHO IS A MEMBER OF A
   45  COLLECTIVE BARGAINING UNIT RECOGNIZED PURSUANT  TO  THE  NATIONAL  LABOR
   46  RELATIONS ACT.
   47    S  4924.  REQUIREMENTS  FOR  HEALTH CARE PROVIDERS' REPRESENTATIVE. 1.
   48  BEFORE ENGAGING IN COLLECTIVE NEGOTIATIONS WITH A HEALTH  CARE  PLAN  ON
   49  BEHALF OF HEALTH CARE PROVIDERS, A HEALTH CARE PROVIDERS' REPRESENTATIVE
   50  SHALL  FILE  WITH  THE  COMMISSIONER,  IN  THE  MANNER PRESCRIBED BY THE
   51  COMMISSIONER, INFORMATION IDENTIFYING THE REPRESENTATIVE, THE  REPRESEN-
   52  TATIVE'S  PLAN  OF  OPERATION,  AND  THE  REPRESENTATIVE'S PROCEDURES TO
   53  ENSURE COMPLIANCE WITH THIS TITLE.
   54    2. BEFORE ENGAGING IN THE COLLECTIVE  NEGOTIATIONS,  THE  HEALTH  CARE
   55  PROVIDERS'  REPRESENTATIVE SHALL ALSO SUBMIT TO THE COMMISSIONER FOR THE
   56  COMMISSIONER'S APPROVAL A REPORT IDENTIFYING THE PROPOSED SUBJECT MATTER
       A. 5692                             5

    1  OF THE NEGOTIATIONS OR DISCUSSIONS WITH THE HEALTH  CARE  PLAN  AND  THE
    2  EFFICIENCIES  OR  BENEFITS  EXPECTED  TO BE ACHIEVED THROUGH THE NEGOTI-
    3  ATIONS FOR BOTH THE PROVIDERS AND  CONSUMERS  OF  HEALTH  SERVICES.  THE
    4  COMMISSIONER  SHALL  NOT  APPROVE  THE  REPORT  IF  THE COMMISSIONER, IN
    5  CONSULTATION WITH THE SUPERINTENDENT OF  FINANCIAL  SERVICES  DETERMINES
    6  THAT  THE PROPOSED NEGOTIATIONS WOULD EXCEED THE AUTHORITY GRANTED UNDER
    7  THIS TITLE.
    8    3. THE REPRESENTATIVE SHALL SUPPLEMENT THE INFORMATION IN  THE  REPORT
    9  ON  A  REGULAR BASIS OR AS NEW INFORMATION BECOMES AVAILABLE, INDICATING
   10  THAT THE SUBJECT MATTER OF THE NEGOTIATIONS WITH THE  HEALTH  CARE  PLAN
   11  HAS  CHANGED  OR  WILL CHANGE. IN NO EVENT SHALL THE REPORT BE LESS THAN
   12  EVERY THIRTY DAYS.
   13    4. WITH THE ADVICE OF THE SUPERINTENDENT OF FINANCIAL SERVICES AND THE
   14  ATTORNEY GENERAL, THE  COMMISSIONER  SHALL  APPROVE  OR  DISAPPROVE  THE
   15  REPORT  NOT  LATER  THAN  THE  TWENTIETH DAY AFTER THE DATE ON WHICH THE
   16  REPORT IS FILED. IF DISAPPROVED, THE COMMISSIONER SHALL FURNISH A  WRIT-
   17  TEN  EXPLANATION OF ANY DEFICIENCIES, ALONG WITH A STATEMENT OF SPECIFIC
   18  PROPOSALS FOR REMEDIAL MEASURES TO CURE THE DEFICIENCIES. IF THE COMMIS-
   19  SIONER DOES NOT SO ACT WITHIN THE  TWENTY  DAYS,  THE  REPORT  SHALL  BE
   20  DEEMED APPROVED.
   21    5.  A PERSON WHO ACTS AS A HEALTH CARE PROVIDERS' REPRESENTATIVE WITH-
   22  OUT THE APPROVAL OF THE COMMISSIONER UNDER THIS SECTION SHALL BE  DEEMED
   23  TO BE ACTING OUTSIDE THE AUTHORITY GRANTED UNDER THIS TITLE.
   24    6.  BEFORE  REPORTING  THE  RESULTS OF NEGOTIATIONS WITH A HEALTH CARE
   25  PLAN OR PROVIDING TO THE AFFECTED HEALTH CARE PROVIDERS AN EVALUATION OF
   26  ANY OFFER MADE BY A HEALTH CARE PLAN, THE HEALTH CARE PROVIDERS'  REPRE-
   27  SENTATIVE SHALL FURNISH FOR APPROVAL BY THE COMMISSIONER, BEFORE DISSEM-
   28  INATION TO THE HEALTH CARE PROVIDERS, A COPY OF ALL COMMUNICATIONS TO BE
   29  MADE  TO THE HEALTH CARE PROVIDERS RELATED TO NEGOTIATIONS, DISCUSSIONS,
   30  AND OFFERS MADE BY THE HEALTH CARE PLAN.
   31    7. A HEALTH CARE PROVIDERS' REPRESENTATIVE   SHALL REPORT THE  END  OF
   32  NEGOTIATIONS TO THE COMMISSIONER NOT LATER THAN THE FOURTEENTH DAY AFTER
   33  THE DATE OF A HEALTH CARE PLAN DECISION DECLINING NEGOTIATION, CANCELING
   34  NEGOTIATIONS,  OR  FAILING  TO RESPOND TO A REQUEST FOR NEGOTIATION.  IN
   35  SUCH INSTANCES, A HEALTH  CARE  PROVIDERS'  REPRESENTATIVE  MAY  REQUEST
   36  INTERVENTION  FROM  THE  COMMISSIONER TO REQUIRE THE HEALTH CARE PLAN TO
   37  PARTICIPATE IN THE NEGOTIATION PURSUANT TO  SUBDIVISION  EIGHT  OF  THIS
   38  SECTION.
   39    8. (A) IN THE EVENT THE COMMISSIONER DETERMINES THAT AN IMPASSE EXISTS
   40  IN  THE  NEGOTIATIONS,  OR  IN  THE EVENT A HEALTH CARE PLAN DECLINES TO
   41  NEGOTIATE, CANCELS NEGOTIATIONS OR FAILS TO RESPOND  TO  A  REQUEST  FOR
   42  NEGOTIATION, THE COMMISSIONER SHALL RENDER ASSISTANCE AS FOLLOWS:
   43    (1)  TO  ASSIST  THE  PARTIES  TO EFFECT A VOLUNTARY RESOLUTION OF THE
   44  NEGOTIATIONS, THE COMMISSIONER SHALL APPOINT A MEDIATOR FROM A  LIST  OF
   45  QUALIFIED  PERSONS  MAINTAINED  BY  THE COMMISSIONER. IF THE MEDIATOR IS
   46  SUCCESSFUL IN RESOLVING THE IMPASSE, THEN  THE  HEALTH  CARE  PROVIDERS'
   47  REPRESENTATIVE SHALL PROCEED AS SET FORTH IN THIS ARTICLE;
   48    (2)  IF  AN  IMPASSE  CONTINUES,  THE  COMMISSIONER  SHALL  APPOINT  A
   49  FACT-FINDING BOARD OF NOT MORE THAN THREE MEMBERS FROM A LIST OF  QUALI-
   50  FIED  PERSONS  MAINTAINED  BY THE COMMISSIONER, WHICH FACT-FINDING BOARD
   51  SHALL HAVE, IN ADDITION TO THE POWERS DELEGATED TO IT BY THE BOARD,  THE
   52  POWER TO MAKE RECOMMENDATIONS FOR THE RESOLUTION OF THE DISPUTE;
   53    (B) THE FACT-FINDING BOARD, ACTING BY A MAJORITY OF ITS MEMBERS, SHALL
   54  TRANSMIT  ITS FINDINGS OF FACT AND RECOMMENDATIONS FOR RESOLUTION OF THE
   55  DISPUTE TO THE COMMISSIONER, AND MAY THEREAFTER ASSIST  THE  PARTIES  TO
   56  EFFECT  A  VOLUNTARY  RESOLUTION  OF THE DISPUTE. THE FACT-FINDING BOARD
       A. 5692                             6

    1  SHALL ALSO SHARE ITS FINDINGS  OF  FACT  AND  RECOMMENDATIONS  WITH  THE
    2  HEALTH CARE PROVIDERS' REPRESENTATIVE AND THE HEALTH CARE PLAN. IF WITH-
    3  IN  TWENTY  DAYS AFTER THE SUBMISSION OF THE FINDINGS OF FACT AND RECOM-
    4  MENDATIONS, THE IMPASSE CONTINUES, THE COMMISSIONER SHALL ORDER A RESOL-
    5  UTION   TO  THE  NEGOTIATIONS  BASED  UPON  THE  FINDINGS  OF  FACT  AND
    6  RECOMMENDATIONS SUBMITTED BY THE FACT-FINDING BOARD.
    7    9. ANY PROPOSED AGREEMENT BETWEEN HEALTH CARE PROVIDERS AND  A  HEALTH
    8  CARE  PLAN  NEGOTIATED  PURSUANT TO THIS TITLE SHALL BE SUBMITTED TO THE
    9  COMMISSIONER FOR FINAL  APPROVAL.  THE  COMMISSIONER  SHALL  APPROVE  OR
   10  DISAPPROVE THE AGREEMENT WITHIN SIXTY DAYS OF SUCH SUBMISSION.
   11    10.  THE  COMMISSIONER  MAY  COLLECT INFORMATION FROM OTHER PERSONS TO
   12  ASSIST IN EVALUATING THE IMPACT  OF  THE  PROPOSED  ARRANGEMENT  ON  THE
   13  HEALTH CARE MARKETPLACE. THE COMMISSIONER SHALL COLLECT INFORMATION FROM
   14  HEALTH  PLAN  COMPANIES  AND HEALTH CARE PROVIDERS OPERATING IN THE SAME
   15  GEOGRAPHIC AREA.
   16    S 4925. CERTAIN COLLECTIVE ACTION PROHIBITED. 1.  THIS  TITLE  IS  NOT
   17  INTENDED  TO AUTHORIZE COMPETING HEALTH CARE PROVIDERS TO ACT IN CONCERT
   18  IN RESPONSE TO A REPORT ISSUED BY THE HEALTH CARE  PROVIDERS'  REPRESEN-
   19  TATIVE  RELATED TO THE REPRESENTATIVE'S DISCUSSIONS OR NEGOTIATIONS WITH
   20  HEALTH CARE PLANS.
   21    2. NO HEALTH CARE PROVIDERS' REPRESENTATIVE SHALL NEGOTIATE ANY AGREE-
   22  MENT THAT EXCLUDES, LIMITS THE PARTICIPATION  OR  REIMBURSEMENT  OF,  OR
   23  OTHERWISE LIMITS THE SCOPE OF SERVICES TO BE PROVIDED BY ANY HEALTH CARE
   24  PROVIDER  OR GROUP OF HEALTH CARE PROVIDERS WITH RESPECT TO THE PERFORM-
   25  ANCE OF SERVICES THAT ARE WITHIN THE HEALTH  CARE  PROVIDER'S  SCOPE  OF
   26  PRACTICE, LICENSE, REGISTRATION, OR CERTIFICATE.
   27    S  4926. FEES. EACH PERSON WHO ACTS AS THE REPRESENTATIVE OR NEGOTIAT-
   28  ING PARTIES UNDER THIS TITLE SHALL PAY TO THE DEPARTMENT A FEE TO ACT AS
   29  A REPRESENTATIVE. THE COMMISSIONER, BY RULE, SHALL SET FEES  IN  AMOUNTS
   30  DEEMED  REASONABLE  AND  NECESSARY  TO  COVER  THE COSTS INCURRED BY THE
   31  DEPARTMENT IN ADMINISTERING THIS TITLE. ANY  FEE  COLLECTED  UNDER  THIS
   32  SECTION  SHALL  BE  DEPOSITED IN THE STATE TREASURY TO THE CREDIT OF THE
   33  GENERAL FUND/STATE OPERATIONS - 003 FOR THE NEW YORK STATE DEPARTMENT OF
   34  HEALTH FUND.
   35    S 4927. MONITORING OF  AGREEMENTS.  THE  COMMISSIONER  SHALL  ACTIVELY
   36  MONITOR  AGREEMENTS  APPROVED UNDER THIS TITLE TO ENSURE THAT THE AGREE-
   37  MENT REMAINS  IN  COMPLIANCE  WITH  THE  CONDITIONS  OF  APPROVAL.  UPON
   38  REQUEST, A HEALTH CARE PLAN OR HEALTH CARE PROVIDER SHALL PROVIDE INFOR-
   39  MATION  REGARDING  COMPLIANCE.  THE  COMMISSIONER MAY REVOKE AN APPROVAL
   40  UPON A FINDING THAT THE AGREEMENT IS NOT IN SUBSTANTIAL COMPLIANCE  WITH
   41  THE TERMS OF THE APPLICATION OR THE CONDITIONS OF APPROVAL.
   42    S 4928. CONFIDENTIALITY. ALL REPORTS AND OTHER INFORMATION REQUIRED TO
   43  BE REPORTED TO THE DEPARTMENT OF LAW UNDER THIS TITLE INCLUDING INFORMA-
   44  TION OBTAINED BY THE COMMISSIONER PURSUANT TO SUBDIVISION TEN OF SECTION
   45  FORTY-NINE  HUNDRED  TWENTY-FOUR  OF  THIS TITLE SHALL NOT BE SUBJECT TO
   46  DISCLOSURE UNDER ARTICLE SIX OF THE PUBLIC OFFICERS LAW OR ARTICLE THIR-
   47  TY-ONE OF THE CIVIL PRACTICE LAW AND RULES.
   48    S 4929. SEVERABILITY AND CONSTRUCTION. THE PROVISIONS  OF  THIS  TITLE
   49  SHALL  BE SEVERABLE, AND IF ANY COURT OF COMPETENT JURISDICTION DECLARES
   50  ANY PHRASE, CLAUSE, SENTENCE OR PROVISION OF THIS TITLE TO  BE  INVALID,
   51  OR  ITS  APPLICABILITY TO ANY GOVERNMENT, AGENCY, PERSON OR CIRCUMSTANCE
   52  IS DECLARED INVALID, THE REMAINDER OF THIS TITLE AND ITS RELEVANT APPLI-
   53  CABILITY SHALL NOT BE AFFECTED. THE PROVISIONS OF THIS  TITLE  SHALL  BE
   54  LIBERALLY CONSTRUED TO GIVE EFFECT TO THE PURPOSES THEREOF.
   55    S 4. This act shall take effect on the one hundred twentieth day after
   56  it  shall have become a law; provided that the commissioner of health is
       A. 5692                             7

    1  authorized to promulgate any and all rules and regulations and take  any
    2  other  measures necessary to implement this act on its effective date on
    3  or before such date.
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