A03076 Summary:

BILL NOA03076A
 
SAME ASNo Same As
 
SPONSORGottfried
 
COSPNSRDinowitz, Galef, Paulin, Rosenthal L, Colton, Jaffee, Abinanti, D'Urso, Lifton
 
MLTSPNSR
 
Amd 4900, Pub Health L; amd 4900, Ins L
 
Relates to the definition of a clinical peer reviewer by clarifying that such term shall be applicable for the entire utilization review and external appeal article and means either a physician or a health care professional with certain qualifications.
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A03076 Actions:

BILL NOA03076A
 
01/28/2019referred to health
05/14/2019reported
05/16/2019advanced to third reading cal.338
05/20/2019passed assembly
05/20/2019delivered to senate
05/20/2019REFERRED TO HEALTH
05/20/2019recalled from senate
05/20/2019RETURNED TO ASSEMBLY
05/20/2019vote reconsidered - restored to third reading
05/21/2019amended on third reading 3076a
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A03076 Committee Votes:

HEALTH Chair:Gottfried DATE:05/14/2019AYE/NAY:16/8 Action: Favorable
GottfriedAyeRaiaNay
SchimmingerNayMcDonoughNay
GalefAyeRaNay
DinowitzAyeGarbarinoNay
CahillNayByrneAye
PaulinAyeByrnesNay
CymbrowitzNayAshbyAye
GuntherAye
RosenthalAye
HevesiAye
JaffeeAye
SteckAye
AbinantiAye
BraunsteinAye
KimExcused
SolagesAye
BichotteExcused
BarronAye
SayeghAye

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A03076 Floor Votes:

DATE:05/20/2019Assembly Vote  YEA/NAY: 120/23
AbbateYCrespoYGanttERLiPetriYPerryYSimonY
AbinantiYCrouchYGarbarinoNOLupardoYPheffer AmatoYSimotasY
ArroyoYCruzERGiglioNOMagnarelliYPichardoYSmithY
AshbyYCusickYGlickYMalliotakisYPretlowYSmullenY
AubryYCymbrowitzYGoodellNOManktelowNOQuartYSolagesY
BarclayNODavilaERGottfriedYMcDonaldYRaYStecNO
BarnwellYDe La RosaYGriffinYMcDonoughYRaiaNOSteckY
BarrettYDenDekkerYGuntherYMcMahonYRamosYSternY
BarronYDeStefanoYHawleyNOMikulinYRaynorYStirpeY
BenedettoYDickensYHevesiYMill B NOReillyYTagueNO
BichotteYDilanERHunterYMill MGYReyesYTaylorY
BlakeYDinowitzYHyndmanYMill MLYRichardsonERThieleY
BlankenbushNODiPietroNOJacobsonYMontesanoYRiveraYTitusER
BrabenecYD'UrsoYJaffeeYMorinelloNORodriguezERVanelY
BraunsteinYEichensteinYJean-PierreYMosleyYRomeoYWalczykNO
BronsonYEnglebrightYJohnsYNiouYRose D YWalkerY
BuchwaldYEpsteinYJonesYNolanYRose L YWallaceY
BurkeYFahyYJoynerYNorrisNORozicYWalshNO
ButtenschonYFallYKimYO'DonnellYRyanYWeinsteinY
ByrneYFernandezYKolbYOrtizYSalkaYWeprinY
ByrnesNOFinchNOLalorNOOtisYSantabarbaraNOWilliamsY
CahillNOFitzpatrickYLavineYPalmesanoNOSayeghYWoernerY
CarrollYFriendYLawrenceYPalumboYSchimmingerNOWrightY
ColtonYFrontusYLentolYPaulinYSchmittYZebrowskiY
CookYGalefYLiftonYPeoples-StokesYSeawrightYMr SpkrY

DATE:05/20/2019MOTION:GOTTFRIED; To reconsider YEA/NAY: 144/0
AbbateYCrespoYGanttERLiPetriYPerryYSimonY
AbinantiYCrouchYGarbarinoYLupardoYPheffer AmatoYSimotasY
ArroyoYCruzERGiglioYMagnarelliYPichardoYSmithY
AshbyYCusickYGlickYMalliotakisYPretlowYSmullenY
AubryYCymbrowitzYGoodellYManktelowYQuartYSolagesY
BarclayYDavilaERGottfriedYMcDonaldYRaYStecY
BarnwellYDe La RosaYGriffinYMcDonoughYRaiaYSteckY
BarrettYDenDekkerYGuntherYMcMahonYRamosYSternY
BarronYDeStefanoYHawleyYMikulinYRaynorYStirpeY
BenedettoYDickensYHevesiYMill B YReillyYTagueY
BichotteYDilanERHunterYMill MGYReyesYTaylorY
BlakeYDinowitzYHyndmanYMill MLYRichardsonERThieleY
BlankenbushYDiPietroYJacobsonYMontesanoYRiveraYTitusY
BrabenecYD'UrsoYJaffeeYMorinelloYRodriguezERVanelY
BraunsteinYEichensteinYJean-PierreYMosleyYRomeoYWalczykY
BronsonYEnglebrightYJohnsYNiouYRose D YWalkerY
BuchwaldYEpsteinYJonesYNolanYRose L YWallaceY
BurkeYFahyYJoynerYNorrisYRozicYWalshY
ButtenschonYFallYKimYO'DonnellYRyanYWeinsteinY
ByrneYFernandezYKolbYOrtizYSalkaYWeprinY
ByrnesYFinchYLalorYOtisYSantabarbaraYWilliamsY
CahillYFitzpatrickYLavineYPalmesanoYSayeghYWoernerY
CarrollYFriendYLawrenceYPalumboYSchimmingerYWrightY
ColtonYFrontusYLentolYPaulinYSchmittYZebrowskiY
CookYGalefYLiftonYPeoples-StokesYSeawrightYMr SpkrY

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A03076 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         3076--A
                                                                Cal. No. 338
 
                               2019-2020 Regular Sessions
 
                   IN ASSEMBLY
 
                                    January 28, 2019
                                       ___________
 
        Introduced by M. of A. GOTTFRIED, DINOWITZ, GALEF, PAULIN, L. ROSENTHAL,
          COLTON,  JAFFEE, ABINANTI, D'URSO, LIFTON -- read once and referred to
          the Committee on Health -- advanced to  a  third  reading,  passed  by
          Assembly  and  delivered to the Senate, recalled from the Senate, vote
          reconsidered, bill amended, ordered reprinted, retaining its place  on
          the order of third reading
 
        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, item (B) of subparagraph
     3  (ii) of paragraph (a) as amended by chapter 41 of the laws of  2014  and
     4  subparagraph  (iii) as amended and subparagraph (iv) of paragraph (a) as
     5  added by section 42 of subpart A of part BB of chapter 57 of the laws of
     6  2019, is amended to read as follows:
     7    2. "Clinical peer reviewer" means:
     8    (a) [for purposes of title one of this article:
     9    (i) a physician who  possesses  a  current  and  valid  non-restricted
    10  license to practice medicine; or
    11    (ii) a health care professional other than a licensed physician who:
    12    (A)  where  applicable,  possesses  a current and valid non-restricted
    13  license, certificate or  registration  or,  where  no  provision  for  a
    14  license,  certificate  or  registration  exists,  is credentialed by the
    15  national accrediting body appropriate to the profession; and
    16    (B) is in the same profession and same or  similar  specialty  as  the
    17  health  care  provider  who  typically  manages the medical condition or
    18  disease or provides the health care service or treatment  under  review;
    19  or
    20    (iii) for purposes of a determination involving substance use disorder
    21  treatment:

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD03373-03-9

        A. 3076--A                          2

     1    (A)  a  physician  who  possesses  a  current and valid non-restricted
     2  license to practice medicine and who specializes  in  behavioral  health
     3  and  has experience in the delivery of substance use disorder courses of
     4  treatment; or
     5    (B)  a  health  care  professional other than a licensed physician who
     6  specializes in behavioral health and has experience in the  delivery  of
     7  substance  use  disorder  courses  of  treatment  and, where applicable,
     8  possesses a current and valid  non-restricted  license,  certificate  or
     9  registration or, where no provision for a license, certificate or regis-
    10  tration  exists, is credentialed by the national accrediting body appro-
    11  priate to the profession; or
    12    (iv) for purposes of a determination involving treatment for a  mental
    13  health condition:
    14    (A)  a  physician  who  possesses  a  current and valid non-restricted
    15  license to practice medicine and who specializes  in  behavioral  health
    16  and  has  experience  in the delivery of mental health courses of treat-
    17  ment; or
    18    (B) a health care professional other than  a  licensed  physician  who
    19  specializes in behavioral health and has experience in the delivery of a
    20  mental  health  courses  of treatment and, where applicable, possesses a
    21  current and valid non-restricted license, certificate,  or  registration
    22  or,  where  no  provision  for  a  license,  certificate or registration
    23  exists, is credentialed by the national accrediting body appropriate  to
    24  the profession; and
    25    (b) for purposes of title two of this article:
    26    (i)] a physician who:
    27    [(A)]  (i)  possesses  a  current  and valid non-restricted license to
    28  practice medicine under article one hundred thirty-one of the  education
    29  law;
    30    [(B)]  (ii)  where applicable, is board certified or board eligible in
    31  the same or similar specialty as the health care provider who  typically
    32  manages  the  medical  condition  or disease or provides the health care
    33  service or treatment under review or appeal;
    34    [(C)] (iii) has been practicing in such area of specialty for a period
    35  of at least five years; [and]
    36    (iv) for purposes of a determination involving substance use  disorder
    37  treatment, possesses a current and valid non-restricted license to prac-
    38  tice medicine and specializes in behavioral health and has experience in
    39  the delivery of substance use disorder courses of treatment;
    40    (v)  for  purposes of a determination involving treatment for a mental
    41  health condition, possesses a current and valid  non-restricted  license
    42  to  practice  medicine  and who specializes in behavioral health and has
    43  experience in the delivery of mental health courses of treatment; and
    44    [(D)] (vi) is knowledgeable about the health care service or treatment
    45  under review or appeal; or
    46    [(ii)] (b) a health care professional other than a licensed  physician
    47  who  possesses  a  current  and  valid non-restricted license or certif-
    48  ication under title eight of the education law:
    49    [(A)] (i) where applicable, possesses a  current  and  valid  non-res-
    50  tricted license, certificate or registration;
    51    [(B)] (ii) where applicable, is credentialed by the national accredit-
    52  ing  body  appropriate to the profession in the same profession and same
    53  or similar specialty as the health care provider who  typically  manages
    54  the  medical condition or disease or provides the health care service or
    55  treatment under review or appeal;

        A. 3076--A                          3
 
     1    [(C)] (iii) has been practicing in such area of specialty for a period
     2  of at least five years;
     3    [(D)] (iv) is knowledgeable about the health care service or treatment
     4  under review or appeal; [and]
     5    (v)  for purposes of a determination involving substance use disorder,
     6  specializes in behavioral health and has experience in the  delivery  of
     7  substance  use  disorder  courses  of  treatment  and, where applicable,
     8  possesses a current and valid  non-restricted  license,  certificate  or
     9  registration or, where no provision for a license, certificate or regis-
    10  tration  exists, is credentialed by the national accrediting body appro-
    11  priate to the profession;
    12    (vi) for purposes of a determination involving treatment for a  mental
    13  health condition, specializes in behavioral health and has experience in
    14  the  delivery  of mental health courses of treatment and, where applica-
    15  ble, possesses a current and valid non-restricted license,  certificate,
    16  or  registration  or,  where  no provision for a license, certificate or
    17  registration exists, is credentialed by the  national  accrediting  body
    18  appropriate to the profession; and
    19    [(E)]  (vii) where applicable to such health care professional's scope
    20  of practice, is clinically supported by  a  physician  who  possesses  a
    21  current and valid non-restricted license to practice medicine.
    22    [(c)]  Nothing  [herein]  in  this  subdivision  shall be construed to
    23  change any statutorily-defined scope of practice.
    24    § 2. Subsection (b) of section 4900 of the insurance law,  as  amended
    25  by  chapter  586  of  the laws of 1998, item (ii) of subparagraph (B) of
    26  paragraph 1 as amended by chapter 41 of the laws of  2014,  subparagraph
    27  (C)  as  amended and subparagraph (D) of paragraph 1 as added by section
    28  36 of subpart A of part BB of chapter 57 of the laws of 2019, is amended
    29  to read as follows:
    30    (b) "Clinical peer reviewer" means:
    31    (1) [for purposes of title one of this article:
    32    (A) a physician who  possesses  a  current  and  valid  non-restricted
    33  license to practice medicine; or
    34    (B) a health care professional other than a licensed physician who:
    35    (i)  where  applicable,  possesses  a current and valid non-restricted
    36  license, certificate or  registration  or,  where  no  provision  for  a
    37  license,  certificate  or  registration  exists,  is credentialed by the
    38  national accrediting body appropriate to the profession; and
    39    (ii) is in the same profession and same or similar  specialty  as  the
    40  health  care  provider  who  typically  manages the medical condition or
    41  disease or provides the health care service or treatment  under  review;
    42  or
    43    (C)  for  purposes of a determination involving substance use disorder
    44  treatment:
    45    (i) a physician who  possesses  a  current  and  valid  non-restricted
    46  license  to  practice  medicine and who specializes in behavioral health
    47  and has experience in the delivery of substance use disorder courses  of
    48  treatment; or
    49    (ii)  a  health  care professional other than a licensed physician who
    50  specializes in behavioral health and has experience in the  delivery  of
    51  substance  use  disorder  courses  of  treatment  and, where applicable,
    52  possesses a current and valid  non-restricted  license,  certificate  or
    53  registration or, where no provision for a license, certificate or regis-
    54  tration  exists, is credentialed by the national accrediting body appro-
    55  priate to the profession; or

        A. 3076--A                          4

     1    (D) for purposes of a determination involving treatment for  a  mental
     2  health condition:
     3    (i)  a  physician  who  possesses  a  current and valid non-restricted
     4  license to practice medicine and who specializes  in  behavioral  health
     5  and  has  experience  in the delivery of mental health courses of treat-
     6  ment; or
     7    (ii) a health care professional other than a  licensed  physician  who
     8  specializes  in  behavioral health and has experience in the delivery of
     9  mental health courses of treatment and, where  applicable,  possesses  a
    10  current  and  valid non-restricted license, certificate, or registration
    11  or, where no  provision  for  a  license,  certificate  or  registration
    12  exists,  is credentialed by the national accrediting body appropriate to
    13  the profession; and
    14    (2) for purposes of title two of this article:
    15    (A)] a physician who:
    16    [(i)] (A) possesses a current  and  valid  non-restricted  license  to
    17  practice  medicine under article one hundred thirty-one of the education
    18  law;
    19    [(ii)] (B) where applicable, is board certified or board  eligible  in
    20  the  same or similar specialty as the health care provider who typically
    21  manages the medical condition or disease or  provides  the  health  care
    22  service or treatment under review or appeal;
    23    [(iii)] (C) has been practicing in such area of specialty for a period
    24  of at least five years; [and]
    25    (D)  for  purposes of a determination involving substance use disorder
    26  treatment, possesses a current and valid non-restricted license to prac-
    27  tice medicine and who specializes in behavioral health and  has  experi-
    28  ence in the delivery of substance use disorder courses of treatment;
    29    (E)  for  purposes of a determination involving treatment for a mental
    30  health condition, possesses a current and valid  non-restricted  license
    31  to  practice  medicine  and who specializes in behavioral health and has
    32  experience in the delivery of mental health courses of treatment; and
    33    [(iv)] (F) is knowledgeable about the health care service or treatment
    34  under review or appeal; or
    35    [(B)] (2) a health care professional other than a  licensed  physician
    36  who  possesses  a  current  and  valid non-restricted license or certif-
    37  ication under title eight of the education law:
    38    [(i)] (A) where applicable, possesses a  current  and  valid  non-res-
    39  tricted license, certificate or registration;
    40    [(ii)] (B) where applicable, is credentialed by the national accredit-
    41  ing  body  appropriate to the profession in the same profession and same
    42  or similar specialty as the health care provider who  typically  manages
    43  the  medical condition or disease or provides the health care service or
    44  treatment under review or appeal;
    45    [(iii)] (C) has been practicing in such area of specialty for a period
    46  of at least five years;
    47    [(iv)] (D) for purposes of a  determination  involving  substance  use
    48  disorder  treatment, specializes in behavioral health and has experience
    49  in the delivery of substance use  disorder  courses  of  treatment  and,
    50  where  applicable, possesses a current and valid non-restricted license,
    51  certificate or registration  or,  where  no  provision  for  a  license,
    52  certificate  or  registration  exists,  is  credentialed by the national
    53  accrediting body appropriate to the profession;
    54    (E) for purposes of a determination involving treatment for  a  mental
    55  health condition, specializes in behavioral health and has experience in
    56  the  delivery  of mental health courses of treatment and, where applica-

        A. 3076--A                          5
 
     1  ble, possesses a current and valid non-restricted license,  certificate,
     2  or  registration  or,  where  no provision for a license, certificate or
     3  registration exists, is credentialed by the  national  accrediting  body
     4  appropriate to the profession;
     5    (F)  is knowledgeable about the health care service or treatment under
     6  review or appeal; and
     7    [(v)] (G) where applicable to such health care professional's scope of
     8  practice, is clinically supported by a physician who possesses a current
     9  and valid non-restricted license to practice medicine.
    10    [(3)] Nothing [herein] in  this  subdivision  shall  be  construed  to
    11  change any statutorily-defined scope of practice.
    12    §  3.  This  act  shall  take  effect on the same date and in the same
    13  manner as subpart A of part BB of chapter 57 of the laws of 2019, or  on
    14  the ninetieth day after it shall have become a law, whichever is later.
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