Bill Text: NY A02693 | 2013-2014 | General Assembly | Introduced
Bill Title: 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.
Spectrum: Partisan Bill (Democrat 11-0)
Status: (Engrossed - Dead) 2014-01-08 - ordered to third reading cal.154 [A02693 Detail]
Download: New_York-2013-A02693-Introduced.html
S T A T E O F N E W Y O R K
________________________________________________________________________
2693
2013-2014 Regular Sessions
I N A S S E M B L Y
January 17, 2013
___________
Introduced by M. of A. GOTTFRIED, DINOWITZ, GALEF, PAULIN, ROSENTHAL,
SCHIMEL, KAVANAGH, COLTON -- Multi-Sponsored by -- M. of A. JACOBS,
KELLNER -- read once and referred to the Committee on Health
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, is amended to read as
3 follows:
4 2. "Clinical peer reviewer" means:
5 (a) [for purposes of title one of this article:
6 (i) a physician who possesses a current and valid non-restricted
7 license to practice medicine; or
8 (ii) a health care professional other than a licensed physician who:
9 (A) where applicable, possesses a current and valid non-restricted
10 license, certificate or registration or, where no provision for a
11 license, certificate or registration exists, is credentialed by the
12 national accrediting body appropriate to the profession; and
13 (B) is in the same profession and same or similar specialty as the
14 health care provider who typically manages the medical condition or
15 disease or provides the health care service or treatment under review;
16 and
17 (b) for purposes of title two of this article:
18 (i)] a physician who:
19 [(A)] (I) possesses a current and valid non-restricted license to
20 practice medicine;
21 [(B)] (II) where applicable, is board certified or board eligible in
22 the same or similar specialty as the health care provider who typically
23 manages the medical condition or disease or provides the health care
24 service or treatment under REVIEW OR appeal;
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD01580-01-3
A. 2693 2
1 [(C)] (III) has been practicing in such area of specialty for a period
2 of at least five years; and
3 [(D)] (IV) is knowledgeable about the health care service or treatment
4 under REVIEW OR appeal; or
5 [(ii)] (B) a health care professional other than a licensed physician
6 who:
7 [(A)] (I) where applicable, possesses a current and valid non-res-
8 tricted license, certificate or registration;
9 [(B)] (II) where applicable, is credentialed by the national accredit-
10 ing body appropriate to the profession in the same profession and same
11 or similar specialty as the health care provider who typically manages
12 the medical condition or disease or provides the health care service or
13 treatment under REVIEW OR appeal;
14 [(C)] (III) has been practicing in such area of specialty for a period
15 of at least five years;
16 [(D)] (IV) is knowledgeable about the health care service or treatment
17 under REVIEW OR appeal; and
18 [(E)] (V) where applicable to such health care professional's scope of
19 practice, is clinically supported by a physician who possesses a current
20 and valid non-restricted license to practice medicine.
21 [(c)] Nothing [herein] IN THIS SUBDIVISION shall be construed to
22 change any statutorily-defined scope of practice.
23 S 2. Subsection (b) of section 4900 of the insurance law, as amended
24 by chapter 586 of the laws of 1998, is amended to read as follows:
25 (b) "Clinical peer reviewer" means:
26 (1) [for purposes of title one of this article:
27 (A) a physician who possesses a current and valid non-restricted
28 license to practice medicine; or
29 (B) a health care professional other than a licensed physician who:
30 (i) where applicable, possesses a current and valid non-restricted
31 license, certificate or registration or, where no provision for a
32 license, certificate or registration exists, is credentialed by the
33 national accrediting body appropriate to the profession; and
34 (ii) is in the same profession and same or similar specialty as the
35 health care provider who typically manages the medical condition or
36 disease or provides the health care service or treatment under review;
37 and
38 (2) for purposes of title two of this article:
39 (A)] a physician who:
40 [(i)] (A) possesses a current and valid non-restricted license to
41 practice medicine;
42 [(ii)] (B) where applicable, is board certified or board eligible in
43 the same or similar specialty as the health care provider who typically
44 manages the medical condition or disease or provides the health care
45 service or treatment under REVIEW OR appeal;
46 [(iii)] (C) has been practicing in such area of specialty for a period
47 of at least five years; and
48 [(iv)] (D) is knowledgeable about the health care service or treatment
49 under REVIEW OR appeal; or
50 [(B)] (2) a health care professional other than a licensed physician
51 who:
52 [(i)] (A) where applicable, possesses a current and valid non-res-
53 tricted license, certificate or registration;
54 [(ii)] (B) where applicable, is credentialed by the national accredit-
55 ing body appropriate to the profession in the same profession and same
56 or similar specialty as the health care provider who typically manages
A. 2693 3
1 the medical condition or disease or provides the health care service or
2 treatment under REVIEW OR appeal;
3 [(iii)] (C) has been practicing in such area of specialty for a period
4 of at least five years;
5 [(iv)] (D) is knowledgeable about the health care service or treatment
6 under REVIEW OR appeal; and
7 [(v)] (E) 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 SUBSECTION shall be construed to change
11 any statutorily-defined scope of practice.
12 S 3. This act shall take effect on the ninetieth day after it shall
13 have become a law.
