STATE OF NEW YORK
________________________________________________________________________
1911--B
Cal. No. 556
2025-2026 Regular Sessions
IN SENATE
January 14, 2025
___________
Introduced by Sens. RIVERA, CLEARE, WEBB -- read twice and ordered
printed, and when printed to be committed to the Committee on Health
-- committee discharged, bill amended, ordered reprinted as amended
and recommitted to said committee -- recommitted to the Committee on
Health in accordance with Senate Rule 6, sec. 8 -- reported favorably
from said committee, ordered to first and second report, ordered to a
third reading, amended and ordered reprinted, retaining its place in
the order of third reading
AN ACT to amend the public health law and the insurance law, in relation
to health care professional applications and terminations
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subdivisions 2, 3, 4, 5, 6, 7, 8 and 9 of section 4406-d of
2 the public health law, as added by chapter 705 of the laws of 1996, are
3 amended to read as follows:
4 2. (a) A health care plan shall not terminate or not renew a contract
5 with a health care professional unless the health care plan provides to
6 the health care professional a written explanation of the reasons for
7 the proposed contract termination and an opportunity for a review or
8 hearing as hereinafter provided. This section shall not apply in cases
9 involving imminent harm to patient care, a determination of fraud, or a
10 final disciplinary action by a state licensing board or other govern-
11 mental agency that impairs the health care professional's ability to
12 practice.
13 (b) The notice of the proposed contract termination or non-renewal
14 provided by the health care plan to the health care professional shall
15 include:
16 (i) the reasons for the proposed action;
17 (ii) notice that the health care professional has the right to request
18 a hearing or review, at the professional's discretion, before a panel
19 appointed by the health care plan;
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD03549-04-6
S. 1911--B 2
1 (iii) a time limit of not less than thirty days within which a health
2 care professional may request a hearing; and
3 (iv) a time limit for a hearing date which must be held within thirty
4 days after the date of receipt of a request for a hearing.
5 (c) The hearing panel shall be comprised of three persons appointed by
6 the health care plan. At least one person on such panel shall be a
7 clinical peer in the same discipline and the same or similar specialty
8 as the health care professional under review. The hearing panel may
9 consist of more than three persons, provided however that the number of
10 clinical peers on such panel shall constitute one-third or more of the
11 total membership of the panel.
12 (d) The hearing panel shall render a decision on the proposed action
13 in a timely manner. Such decision shall include reinstatement of the
14 health care professional by the health care plan, provisional rein-
15 statement subject to conditions set forth by the health care plan or
16 termination of the health care professional. Such decision shall be
17 provided in writing to the health care professional.
18 (e) A decision by the hearing panel to terminate or not renew a health
19 care professional shall be effective not less than thirty days after the
20 receipt by the health care professional of the hearing panel's decision;
21 provided, however, that the provisions of paragraph (e) of subdivision
22 six of section [four thousand four] forty-four hundred three of this
23 article shall apply to such termination or non-renewal.
24 (f) In no event shall termination be effective earlier than sixty days
25 from the receipt of the notice of termination.
26 3. [Either party to a contract may exercise a right of non-renewal at
27 the expiration of the contract period set forth therein or, for a
28 contract without a specific expiration date, on each January first
29 occurring after the contract has been in effect for at least one year,
30 upon sixty days notice to the other party; provided, however, that any
31 non-renewal shall not constitute a termination for purposes of this
32 section.
33 4.] A health care plan shall develop and implement policies and proce-
34 dures to ensure that health care professionals are regularly informed of
35 information maintained by the health care plan to evaluate the perform-
36 ance or practice of the health care professional. The health care plan
37 shall consult with health care professionals in developing methodologies
38 to collect and analyze health care professional profiling data. Health
39 care plans shall provide any such information and profiling data and
40 analysis to health care professionals. Such information, data or analy-
41 sis shall be provided on a periodic basis appropriate to the nature and
42 amount of data and the volume and scope of services provided. Any
43 profiling data used to evaluate the performance or practice of a health
44 care professional shall be measured against stated criteria and an
45 appropriate group of health care professionals using similar treatment
46 modalities serving a comparable patient population. Upon presentation of
47 such information or data, each health care professional shall be given
48 the opportunity to discuss the unique nature of the health care profes-
49 sional's patient population which may have a bearing on the health care
50 professional's profile and to work cooperatively with the health care
51 plan to improve performance.
52 [5.] 4. No health care plan shall terminate a contract or employment,
53 or refuse to renew a contract, solely because a health care provider
54 has:
55 (a) advocated on behalf of an enrollee;
56 (b) filed a complaint against the health care plan;
S. 1911--B 3
1 (c) appealed a decision of the health care plan;
2 (d) provided information or filed a report pursuant to section forty-
3 four hundred six-c of this article; or
4 (e) requested a hearing or review pursuant to this section.
5 [6.] 5. Except as provided herein, no contract or agreement between a
6 health care plan and a health care professional shall contain any
7 provision which shall supersede or impair a health care professional's
8 right to notice of reasons for termination or non-renewal and the oppor-
9 tunity for a hearing or review concerning such termination or non-rene-
10 wal.
11 [7.] 6. Any contract provision in violation of this section shall be
12 deemed to be void and unenforceable.
13 [8.] 7. For purposes of this section, "health care plan" shall mean a
14 health maintenance organization licensed pursuant to article forty-three
15 of the insurance law or certified pursuant to this article or an inde-
16 pendent practice association certified or recognized pursuant to this
17 article.
18 [9.] 8. For purposes of this section, "health care professional" shall
19 mean a health care professional licensed, registered or certified pursu-
20 ant to title eight of the education law.
21 § 2. Subsections (b), (c), (d), (e), (f), (g) and (h) of section 4803
22 of the insurance law, as added by chapter 705 of the laws of 1996, are
23 amended to read as follows:
24 (b) (1) An insurer shall not terminate or not renew a contract with a
25 health care professional for participation in the in-network benefits
26 portion of the insurer's network for a managed care product unless the
27 insurer provides to the health care professional a written explanation
28 of the reasons for the proposed contract termination and an opportunity
29 for a review or hearing as hereinafter provided. This section shall not
30 apply in cases involving imminent harm to patient care, a determination
31 of fraud, or a final disciplinary action by a state licensing board or
32 other governmental agency that impairs the health care professional's
33 ability to practice.
34 (2) The notice of the proposed contract termination or non-renewal
35 provided by the insurer to the health care professional shall include:
36 (i) the reasons for the proposed action;
37 (ii) notice that the health care professional has the right to request
38 a hearing or review, at the professional's discretion, before a panel
39 appointed by the insurer;
40 (iii) a time limit of not less than thirty days within which a health
41 care professional may request a hearing or review; and
42 (iv) a time limit for a hearing date which must be held within not
43 less than thirty days after the date of receipt of a request for a hear-
44 ing.
45 (3) The hearing panel shall be comprised of three persons appointed by
46 the insurer. At least one person on such panel shall be a clinical peer
47 in the same discipline and the same or similar specialty as the health
48 care professional under review. The hearing panel may consist of more
49 than three persons, provided however that the number of clinical peers
50 on such panel shall constitute one-third or more of the total membership
51 of the panel.
52 (4) The hearing panel shall render a decision on the proposed action
53 in a timely manner. Such decision shall include reinstatement of the
54 health care professional by the insurer, provisional reinstatement
55 subject to conditions set forth by the insurer or termination of the
S. 1911--B 4
1 health care professional. Such decision shall be provided in writing to
2 the health care professional.
3 (5) A decision by the hearing panel to terminate or not renew a health
4 care professional shall be effective not less than thirty days after the
5 receipt by the health care professional of the hearing panel's decision;
6 provided, however, that the provisions of subsection (e) of section four
7 thousand eight hundred four of this article shall apply to such termi-
8 nation.
9 (6) In no event shall termination or non-renewal be effective earlier
10 than sixty days from the receipt of the notice of termination or non-re-
11 newal.
12 (c) [Either party to a contract for participation in the in-network
13 benefits portion of an insurer's network for a managed care product may
14 exercise a right of non-renewal at the expiration of the contract period
15 set forth therein or, for a contract without a specific expiration date,
16 on each January first occurring after the contract has been in effect
17 for at least one year, upon sixty days notice to the other party;
18 provided, however, that any non-renewal shall not constitute a termi-
19 nation for purposes of this section.
20 (d)] An insurer shall develop and implement policies and procedures to
21 ensure that health care providers participating in [the] the in-network
22 benefits portion of an insurer's network for a managed care product are
23 regularly informed of information maintained by the insurer to evaluate
24 the performance or practice of the health care professional. The insurer
25 shall consult with health care professionals in developing methodologies
26 to collect and analyze provider profiling data. Insurers shall provide
27 any such information and profiling data and analysis to these health
28 care professionals. Such information, data or analysis shall be provided
29 on a periodic basis appropriate to the nature and amount of data and the
30 volume and scope of services provided. Any profiling data used to evalu-
31 ate the performance or practice of such a health care professional shall
32 be measured against stated criteria and an appropriate group of health
33 care professionals using similar treatment modalities serving a compara-
34 ble patient population. Upon presentation of such information or data,
35 each such health care professional shall be given the opportunity to
36 discuss the unique nature of the health care professional's patient
37 population which may have a bearing on the professional's profile and to
38 work cooperatively with the insurer to improve performance.
39 [(e)] (d) No insurer shall terminate or refuse to renew a contract for
40 participation in the in-network benefits portion of an insurer's network
41 for a managed care product solely because the health care professional
42 has (1) advocated on behalf of an insured; (2) has filed a complaint
43 against the insurer; (3) has appealed a decision of the insurer; (4)
44 provided information or filed a report pursuant to section forty-four
45 hundred six-c of the public health law; or (5) requested a hearing or
46 review pursuant to this section.
47 [(f)] (e) Except as provided herein, no contract or agreement between
48 an insurer and a health care professional for participation in the
49 in-network benefits portion of an insurer's network for a managed care
50 product shall contain any provision which shall supersede or impair a
51 health care professional's right to notice of reasons for termination or
52 non-renewal and the opportunity for a hearing concerning such termi-
53 nation or non-renewal.
54 [(g)] (f) Any contract provision in violation of this section shall be
55 deemed to be void and unenforceable.
S. 1911--B 5
1 [(h)] (g) For purposes of this section, "health care professional"
2 shall mean a health care professional licensed, registered or certified
3 pursuant to title eight of the education law.
4 § 3. This act shall take effect immediately.
