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Who cares
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Sponsors
2 Co-sponsors
History
- Print number 4453a
- Amend and recommit to insurance
- Referred to insurance
- Referred to insurance
Full text
The text isn't available here yet. Check nysenate.gov.
Sponsor's memo
BILL NUMBER:S4453A
Title of bill
An act to amend the insurance law and the public health law, in relation to the definitions of "clinical peer reviewer" for the purposes of utilization review and external appeal
Purpose
To require clinical peer reviewers to be licensed, registered or certi- fied in this state and to be in the same specialty as the health care provider being reviewed.
Summary of provisions
Section 1. Subsection (b) of section 4900 of the insurance law, as amended by chapter 586 of the laws of 1998, is amended to read as follows: "Clinical peer reviewer" means (A) a physician who possesses a current and valid nonrestricted license to practice medicine pursuant to article one hundred thirty-one of the education law. (8) a health care professional other than a licensed physician who: is credentialed by the national accrediting body appropriate to the profession issued pursuant to title eight of the education law.
Justification
Currently, clinical peer reviewers of insurance claims are required to be in the same profession or similar specialty as the health care provider providing the treatment that is subject to review. This has allowed clinical peer reviewers to deny insurance claims regarding a medical condition or treatment in which he or she has no expertise or specialized education. This bill would require clinical peer reviewers to be licensed, registered or certified in the same specialty as the health care provider being reviewed. In addition, this bill would require all clinical peer reviewers conducting utilization review and external appeals for New York patients to be licensed, registered or certified in New York State.
Legislative history
New legislation.
Fiscal implications
To be determined.
Effective date
This act shall take effect on the one hundred twentieth day after it shall have become law.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.