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A00662 Summary:

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A00662 Floor Votes:

A00662 Text:

 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                           662
 
                               2011-2012 Regular Sessions
 
                   IN ASSEMBLY
 
                                       (Prefiled)
 
                                     January 5, 2011
                                       ___________
 
        Introduced  by  M.  of  A. GOTTFRIED, DINOWITZ, GALEF, KAVANAGH, PAULIN,
          SCHIMEL -- Multi-Sponsored by -- M. of A. JACOBS, KELLNER,  J. MILLER,
          TOWNS -- read once and referred to the Committee on Health
 
        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:
 
     1    Section 1. Subdivision 2 of section 4900 of the public health law,  as
     2  amended  by  chapter  586  of  the  laws  of 1998, is amended to read as
     3  follows:
     4    2. "Clinical peer reviewer" means:
     5    (a) [for purposes of title one of this article:
     6    (i) a physician who  possesses  a  current  and  valid  non-restricted
     7  license to practice medicine; or
     8    (ii) a health care professional other than a licensed physician who:
     9    (A)  where  applicable,  possesses  a current and valid non-restricted
    10  license, certificate or  registration  or,  where  no  provision  for  a

    11  license,  certificate  or  registration  exists,  is credentialed by the
    12  national accrediting body appropriate to the profession; and
    13    (B) is in the same profession and same or  similar  specialty  as  the
    14  health  care  provider  who  typically  manages the medical condition or
    15  disease or provides the health care service or treatment  under  review;
    16  and
    17    (b) for purposes of title two of this article:
    18    (i)] a physician who:
    19    [(A)]  (i)  possesses  a  current  and valid non-restricted license to
    20  practice medicine;
    21    [(B)] (ii) where applicable, is board certified or board  eligible  in
    22  the  same or similar specialty as the health care provider who typically
 

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD02275-01-1
        A. 662                              2
 
     1  manages the medical condition or disease or  provides  the  health  care
     2  service or treatment under review or appeal;
     3    [(C)] (iii) has been practicing in such area of specialty for a period
     4  of at least five years; and
     5    [(D)] (iv) is knowledgeable about the health care service or treatment
     6  under review or appeal; or
     7    [(ii)]  (b) a health care professional other than a licensed physician
     8  who:

     9    [(A)] (i) where applicable, possesses a  current  and  valid  non-res-
    10  tricted license, certificate or registration;
    11    [(B)] (ii) where applicable, is credentialed by the national accredit-
    12  ing  body  appropriate to the profession in the same profession and same
    13  or similar specialty as the health care provider who  typically  manages
    14  the  medical condition or disease or provides the health care service or
    15  treatment under review or appeal;
    16    [(C)] (iii) has been practicing in such area of specialty for a period
    17  of at least five years;
    18    [(D)] (iv) is knowledgeable about the health care service or treatment
    19  under review or appeal; and
    20    [(E)] (v) where applicable to such health care professional's scope of

    21  practice, is clinically supported by a physician who possesses a current
    22  and valid non-restricted license to practice medicine.
    23    [(c)] Nothing [herein] in  this  subdivision  shall  be  construed  to
    24  change any statutorily-defined scope of practice.
    25    §  2.  Subsection (b) of section 4900 of the insurance law, as amended
    26  by chapter 586 of the laws of 1998, is amended to read as follows:
    27    (b) "Clinical peer reviewer" means:
    28    (1) [for purposes of title one of this article:
    29    (A) a physician who  possesses  a  current  and  valid  non-restricted
    30  license to practice medicine; or
    31    (B) a health care professional other than a licensed physician who:
    32    (i)  where  applicable,  possesses  a current and valid non-restricted

    33  license, certificate or  registration  or,  where  no  provision  for  a
    34  license,  certificate  or  registration  exists,  is credentialed by the
    35  national accrediting body appropriate to the profession; and
    36    (ii) is in the same profession and same or similar  specialty  as  the
    37  health  care  provider  who  typically  manages the medical condition or
    38  disease or provides the health care service or treatment  under  review;
    39  and
    40    (2) for purposes of title two of this article:
    41    (A)] a physician who:
    42    [(i)]  (A)  possesses  a  current  and valid non-restricted license to
    43  practice medicine;
    44    [(ii)] (B) where applicable, is board certified or board  eligible  in

    45  the  same or similar specialty as the health care provider who typically
    46  manages the medical condition or disease or  provides  the  health  care
    47  service or treatment under review or appeal;
    48    [(iii)] (C) has been practicing in such area of specialty for a period
    49  of at least five years; and
    50    [(iv)] (D) is knowledgeable about the health care service or treatment
    51  under review or appeal; or
    52    [(B)]  (2)  a health care professional other than a licensed physician
    53  who:
    54    [(i)] (A) where applicable, possesses a  current  and  valid  non-res-
    55  tricted license, certificate or registration;
        A. 662                              3
 

     1    [(ii)] (B) where applicable, is credentialed by the national accredit-
     2  ing  body  appropriate to the profession in the same profession and same
     3  or similar specialty as the health care provider who  typically  manages
     4  the  medical condition or disease or provides the health care service or
     5  treatment under review or appeal;
     6    [(iii)] (C) has been practicing in such area of specialty for a period
     7  of at least five years;
     8    [(iv)] (D) is knowledgeable about the health care service or treatment
     9  under review or appeal; and
    10    [(v)] (E) where applicable to such health care professional's scope of
    11  practice, is clinically supported by a physician who possesses a current
    12  and valid non-restricted license to practice medicine.

    13    [(3)] Nothing [herein] in this subsection shall be construed to change
    14  any statutorily-defined scope of practice.
    15    §  3.  This  act shall take effect on the ninetieth day after it shall
    16  have become a law.