What's happening
This bill prohibits hospitals, health care plans, and insurers from denying privileges or network participation solely because a physician is no longer board-certified.
Why it matters
Protects experienced physicians. By preventing hospitals, health plans, and insurers from denying privileges solely because a doctor’s board certification has lapsed, the bill safeguards access to experienced doctors who may have chosen not to maintain certification for various reasons (e.g., cost, time, philosophical objections).
Potentially broadens patient choice. Patients could have access to a wider pool of providers, including those with long-standing clinical experience but without current board certification, rather than being limited only to those with up-to-date credentials.
Shifts focus to competency over credentials. The bill emphasizes that professional participation decisions should relate to actual quality of care, competency, and patient safety—rather than administrative or bureaucratic requirements that may not directly impact clinical ability.
May influence professional associations’ leverage. The legislation could reduce the influence that specialty boards have over physicians by making recertification less essential for practicing in hospitals or joining insurance networks, potentially changing how ongoing education and credentialing are valued in the medical field.
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Who cares
Headline styles
No Board Cert? No Problem
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Print number 7357a
- Amend and recommit to health
- Referred to health
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Stop Physician Board Certification Bias
In Assembly Committee · Health · Sponsor Robin Schimminger
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
7357--A
IN SENATE
January 9, 2018
Introduced by Sen. DeFRANCISCO -- 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
AN ACT to amend the public health law and the insurance law, in relation to improper practices relating to staff membership or professional privileges of a physician and board certification
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Subdivision 1 of section 2801-b of the public health law, as amended by chapter 605 of the laws of 2008, is amended to read as follows:
1. It shall be an improper practice for the governing body of a hospital to refuse to act upon an application for staff membership or professional privileges or to deny or withhold from a physician, podiatrist, optometrist, dentist or licensed midwife staff membership or professional privileges in a hospital, or to exclude or expel a physician, podiatrist, optometrist, dentist or licensed midwife from staff membership in a hospital or curtail, terminate or diminish in any way a physician's, podiatrist's, optometrist's, dentist's or licensed midwife's professional privileges in a hospital, without stating the reasons therefor, or if the reasons stated are unrelated to standards of patient care, patient welfare, the objectives of the institution or the character or competency of the applicant. It shall be an improper practice for a governing body of a hospital to refuse to act upon an application or to deny or to withhold staff membership or professional privileges to a podiatrist based solely upon a practitioner's category of licensure. It shall be an improper practice for a governing body of a hospital to refuse to act upon an application or to deny or to withhold staff membership or professional privileges of a physician who was previously board-certified and who has not maintained such certification solely because such physician is not board-certified.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD09068-07-8
S. 7357--A 2
§ 2. Paragraph (a) of subdivision 1 of section 4406-d of the public health law, as amended by chapter 425 of the laws of 2016, is amended to read as follows:
(a) A health care plan shall, upon request, make available and disclose to health care professionals written application procedures and minimum qualification requirements which a health care professional must meet in order to be considered by the health care plan. The plan shall consult with appropriately qualified health care professionals in developing its qualification requirements. A health care plan shall complete review of the health care professional's application to participate in the in-network portion of the health care plan's network and shall, within sixty days of receiving a health care professional's completed application to participate in the health care plan's network, notify the health care professional as to: (i) whether he or she is credentialed; or (ii) whether additional time is necessary to make a determination because of a failure of a third party to provide necessary documentation. In such instances where additional time is necessary because of a lack of necessary documentation, a health plan shall make every effort to obtain such information as soon as possible and shall make a final determination within twenty-one days of receiving the necessary documentation. A health care plan may not refuse to approve an application from a physician, who was previously board-certified and who has not maintained such certification, to participate in the in-network portion of the health care plan's network solely because such physician is not board-certified.
§ 3. Paragraph 1 of subsection (a) of section 4803 of the insurance law, as amended by chapter 425 of the laws of 2016, is amended to read as follows:
(1) An insurer which offers a managed care product shall, upon request, make available and disclose to health care professionals written application procedures and minimum qualification requirements which a health care professional must meet in order to be considered by the insurer for participation in the in-network benefits portion of the insurer's network for the managed care product. The insurer shall consult with appropriately qualified health care professionals in developing its qualification requirements for participation in the in-network benefits portion of the insurer's network for the managed care product. An insurer shall complete review of the health care professional's application to participate in the in-network portion of the insurer's network and, within sixty days of receiving a health care professional's completed application to participate in the insurer's network, will notify the health care professional as to: (A) whether he or she is credentialed; or (B) whether additional time is necessary to make a determination because of a failure of a third party to provide necessary documentation. In such instances where additional time is necessary because of a lack of necessary documentation, an insurer shall make every effort to obtain such information as soon as possible and shall make a final determination within twenty-one days of receiving the necessary documentation. An insurer may not refuse to approve an application from a physician, who was previously board-certified and who has not maintained such certification, for participation in the in-network portion of the insurer's network solely because such physician is not board-certified.
§ 4. This act shall take effect immediately.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act to amend the public health law and the insurance law, in relation to improper practices relating to staff membership or professional priv- ileges of a physician and board certification
Purpose
To prohibit health insurance companies and hospitals from mandating that their network and staff physicians continue to maintain board board certification as a condition of participating in their panels and medical staffs.
Summary of provisions
Section 1 of the bill would amend Section 2801-b of the Public Health Law to prohibit the governing body of a hospital to refuse to grant staff membership or professional privileges to a physician who was previously board-certified solely because such physician has not main- tained such board certification.
Section 2 of the bill would amend Section 4406-d of the Public Health Law to prohibit an HMO from denying an application for participation in the HMO's network to a physician who was previously board-certified solely because such physician has not maintained such board certif- ication.
Section 3 of the bill would amend Section 4803 of the Insurance Law to prohibit a health insurer from denying an application for participation in that health insurer's network to a physician who was previously board-certified solely because such physician has not maintained such board certification.
Section 4 - Effective date
Justification
The cost of obtaining and updating board certification status is increasingly becoming prohibitively expensive for many physicians at a time when they are already being squeezed between rapidly increasing office overhead costs and cuts in insurer payment. Physicians are gener- ally granted state medical licenses based upon successfully passing medical school and internship examinations. Beyond that, most physi- cians aspire to obtain specialty board certification as it helps to denote to the public that the physician is appropriately qualified to treat various medical conditions typically treated by that specialty, and advances in healthcare have required physicians to remain current in their own specialty on a continuing basis. Physicians generally remain current in their knowledge base by attending seminars, reading journals, discussions with other physicians, and various other endeavors which are designed to continually improve a physician's delivery of medical care.
Many also seek to achieve and continually update their board certif- ication status. These various specialty boards belong to a parent organ- ization, the American Board of Medical Specialties (ABMS), which has become increasingly active in lobbying for recertification examinations to be mandatory on a periodic basis throughout a physician's career. While initial board certification is an important step in a physician's development, recertification on a periodic basis is not only unneces- sary, there is no evidence that such recertification actually improves the delivery of healthcare. Moreover, the costs are becoming increas- ingly prohibitively expensive. For older physicians, the cost may drive them out of practicing medicine altogether. This legislation would help to ensure that board certification remains aspirational for physicians, but not mandatory, by ensuring that hospitals and health insurance companies cannot impose such requirements as a condition of partic- ipation, thereby reducing one barrier to delivering medical care in New York State.
Legislative history
2015-2016: A.5650; 2013-2014: A. 8979.
Fiscal implications
None.
Effective date
This act shall take effect immediately.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.