Relates to health care professional applications and terminations

BILL NUMBER:S5762

Title of bill

An act to amend the public health law and the insurance law, in relation to health care professional applications and terminations

Purpose

To provide health care practitioners with due process protections in order to allow and encourage a meaningful continuity of care to health insurance enrollees.

Summary of provisions

Section one amends section 4406-d of the Public Health Law to clarify the due process protections afforded to a health care professional for contract terminations. This section also refines the process by which members of a hearing panel are chosen to require that one member is appointed by the insurer, one member is appointed by the subject of the hearing and that the third panelist is chosen by the other two panel members.

Section two amends section 4803 of the Insurance Law to clarify that the due process protections afforded to a health care professional for contract terminations. This section also refines the process by which members of a hearing panel are chosen to require that one member is appointed by the insurer, one member is appointed by the subject of the hearing and that the third panelist is chosen by the other two panel members.

Section three contains the effective date, which is immediate.

Justification

The relationship between a patient and his or her physician is integral to the effective, efficient provision of quality health care services. The better a physician knows a patient, knows the patient's history, is aware of the patients level of participation in improving his or her own health and can meld these factors with the scientific practice of medicine, the more likely the patient will receive the best and most efficient health care.

As part of New York's Managed Care Bill of Rights, the Legislature recognized the value gained by preserving the patients relationships with their provider by establishing meaningful due process protections for all providers by prohibiting plans from terminating a provider without notice and without an opportunity to be heard by a panel of clinical peers. However, in some instances insurers have avoided triggering these important protections by waiting to drop physicians from their panels until the expiration of their participating contract for reasons that may be related to these physicians challenging the insurer's payment practices or the physician's referral of patients to certain needed specialists. This bill would extend these important statutory due process protections, currently applicable to contract terminations, to contract non-renewals to assure that such non-renewals occur for valid reasons.

Fiscal implications

None.

Effective date

Immediately.