S T A T E O F N E W Y O R K
________________________________________________________________________
3563
2013-2014 Regular Sessions
I N A S S E M B L Y
January 28, 2013
___________
Introduced by M. of A. PRETLOW, GOTTFRIED, CAHILL, COLTON, MAGNARELLI,
GALEF, PAULIN, SCHIMEL, LIFTON, CUSICK, O'DONNELL, RIVERA, JAFFEE,
WEISENBERG, PERRY, RUSSELL, MARKEY, BRONSON, ROSENTHAL, KELLNER,
LAVINE, THIELE, BENEDETTO, TITONE, BOYLAND, PEOPLES-STOKES, GUNTHER,
WEPRIN, ABINANTI, ENGLEBRIGHT, ROBERTS, MAISEL -- Multi-Sponsored by
-- M. of A. ABBATE, AUBRY, BRENNAN, COOK, CYMBROWITZ, DINOWITZ, GLICK,
HEASTIE, HIKIND, HOOPER, JACOBS, LENTOL, V. LOPEZ, LOSQUADRO, LUPARDO,
MAGEE, MALLIOTAKIS, MILLMAN, MONTESANO, ORTIZ, RA, RAIA, SCARBOROUGH,
SWEENEY, WEINSTEIN, WRIGHT -- read once and referred to the Committee
on Health
AN ACT to amend the public health law, in relation to requirements for
collective negotiations by health care providers with certain health
benefit plans in certain counties, and providing for the repeal of
such provisions upon the expiration thereof
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
1 Section 1. Statement of legislative intent. The legislature finds that
2 collective negotiation by competing health care providers for the terms
3 and conditions of contracts with health plans can result in beneficial
4 results for health care consumers. The legislature further finds
5 instances where health plans dominate the market to such a degree that
6 fair and adequate negotiations between health care providers and the
7 plans are adversely affected, so that it is necessary and appropriate to
8 provide for a demonstration to examine the risks and benefits associated
9 with a system of collective action on behalf of health care providers.
10 Consequently, the legislature finds it appropriate and necessary in the
11 demonstration service area to displace competition with regulation of
12 health plan-provider agreements and authorize collective negotiations on
13 the terms and conditions of the relationship between health care plans
14 and health care providers so the imbalances between the two will not
15 result in adverse conditions of health care. This act is not intended to
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD02579-02-3
A. 3563 2
1 apply to or affect in any respect collective bargaining relationships
2 involving health care providers as defined in section 4920 of the public
3 health law or rights relating to collective bargaining arising under
4 applicable federal or state collective bargaining statutes.
5 S 2. This act shall be known and may be cited as the "health care
6 consumer and provider protection act".
7 S 3. Article 49 of the public health law is amended by adding a new
8 title III to read as follows:
9 TITLE III
10 COLLECTIVE NEGOTIATIONS BY HEALTH CARE
11 PROVIDERS WITH HEALTH CARE PLANS
12 SECTION 4920. DEFINITIONS.
13 4921. NON-FEE RELATED COLLECTIVE NEGOTIATION AUTHORIZED.
14 4922. FEE RELATED COLLECTIVE NEGOTIATION.
15 4923. COLLECTIVE NEGOTIATION REQUIREMENTS.
16 4924. REQUIREMENTS FOR HEALTH CARE PROVIDERS' REPRESENTATIVE.
17 4925. CERTAIN COLLECTIVE ACTION PROHIBITED.
18 4926. FEES.
19 4927. MONITORING OF AGREEMENTS.
20 4928. CONFIDENTIALITY.
21 4929. SEVERABILITY AND CONSTRUCTION.
22 S 4920. DEFINITIONS. FOR PURPOSES OF THIS TITLE:
23 1. "HEALTH CARE PLAN" MEANS AN ENTITY (OTHER THAN A HEALTH CARE
24 PROVIDER) THAT APPROVES, PROVIDES, ARRANGES FOR, OR PAYS FOR HEALTH CARE
25 SERVICES IN THE DEMONSTRATION SERVICE AREA, INCLUDING BUT NOT LIMITED
26 TO:
27 (A) A HEALTH MAINTENANCE ORGANIZATION LICENSED PURSUANT TO ARTICLE
28 FORTY-THREE OF THE INSURANCE LAW OR CERTIFIED PURSUANT TO ARTICLE
29 FORTY-FOUR OF THIS CHAPTER;
30 (B) ANY OTHER ORGANIZATION CERTIFIED PURSUANT TO ARTICLE FORTY-FOUR OF
31 THIS CHAPTER; OR
32 (C) AN INSURER OR CORPORATION SUBJECT TO THE INSURANCE LAW.
33 2. "PERSON" MEANS AN INDIVIDUAL, ASSOCIATION, CORPORATION, OR ANY
34 OTHER LEGAL ENTITY.
35 3. "HEALTH CARE PROVIDERS' REPRESENTATIVE" MEANS A THIRD PARTY WHO IS
36 AUTHORIZED BY HEALTH CARE PROVIDERS TO NEGOTIATE ON THEIR BEHALF WITH
37 HEALTH CARE PLANS OVER CONTRACTUAL TERMS AND CONDITIONS AFFECTING THOSE
38 HEALTH CARE PROVIDERS.
39 4. "STRIKE" MEANS A WORK STOPPAGE IN PART OR IN WHOLE, DIRECT OR INDI-
40 RECT, BY A BODY OF WORKERS TO GAIN COMPLIANCE WITH DEMANDS MADE ON AN
41 EMPLOYER.
42 5. "SUBSTANTIAL MARKET SHARE IN A BUSINESS LINE" EXISTS IF A HEALTH
43 CARE PLAN'S MARKET SHARE OF A BUSINESS LINE WITHIN THE DEMONSTRATION
44 SERVICE AREA AS APPROVED BY THE COMMISSIONER, IN CONSULTATION WITH THE
45 SUPERINTENDENT OF FINANCIAL SERVICES, ALONE OR IN COMBINATION WITH THE
46 MARKET SHARES OF AFFILIATES, EXCEEDS EITHER TEN PERCENT OF THE TOTAL
47 NUMBER OF COVERED LIVES IN THAT SERVICE AREA FOR SUCH BUSINESS LINE OR
48 TWENTY-FIVE THOUSAND LIVES, OR IF THE COMMISSIONER, IN CONSULTATION WITH
49 THE SUPERINTENDENT OF FINANCIAL SERVICES, DETERMINES THE MARKET SHARE OF
50 THE INSURER IN THE RELEVANT INSURANCE PRODUCT AND GEOGRAPHIC MARKETS FOR
51 THE SERVICES OF THE PROVIDERS SEEKING TO COLLECTIVELY NEGOTIATE SIGNIF-
52 ICANTLY EXCEEDS THE COUNTERVAILING MARKET SHARE OF THE PROVIDERS ACTING
53 INDIVIDUALLY.
54 6. "HEALTH CARE PROVIDER" MEANS A PERSON WHO IS LICENSED, CERTIFIED,
55 OR REGISTERED PURSUANT TO TITLE EIGHT OF THE EDUCATION LAW AND WHO PRAC-
56 TICES AS A HEALTH CARE PROVIDER AS AN INDEPENDENT CONTRACTOR AND/OR WHO
A. 3563 3
1 IS AN OWNER, OFFICER, SHAREHOLDER, OR PROPRIETOR OF A HEALTH CARE
2 PROVIDER IN THE DEMONSTRATION SERVICE AREA. A HEALTH CARE PROVIDER
3 UNDER TITLE EIGHT OF THE EDUCATION LAW WHO PRACTICES AS AN EMPLOYEE OF A
4 HEALTH CARE PROVIDER SHALL NOT BE DEEMED A HEALTH CARE PROVIDER FOR
5 PURPOSES OF THIS TITLE.
6 7. "DEMONSTRATION SERVICE AREA" SHALL INCLUDE THE COUNTIES OF ALBANY,
7 COLUMBIA, GREENE, ORANGE, RENSSELAER, SARATOGA, SCHENECTADY, SCHOHARIE,
8 ULSTER, WARREN AND WASHINGTON.
9 S 4921. NON-FEE RELATED COLLECTIVE NEGOTIATION AUTHORIZED. 1. HEALTH
10 CARE PROVIDERS PRACTICING WITHIN THE DEMONSTRATION SERVICE AREA MAY MEET
11 AND COMMUNICATE FOR THE PURPOSE OF COLLECTIVELY NEGOTIATING WITH A
12 HEALTH CARE PLAN THE FOLLOWING TERMS AND CONDITIONS OF PROVIDER
13 CONTRACTS WITH THE HEALTH CARE PLAN:
14 (A) THE DETAILS OF THE UTILIZATION REVIEW PLAN AS DEFINED PURSUANT TO
15 SUBDIVISION TEN OF SECTION FORTY-NINE HUNDRED OF THIS ARTICLE AND
16 SUBSECTION (J) OF SECTION FOUR THOUSAND NINE HUNDRED OF THE INSURANCE
17 LAW;
18 (B) COVERAGE PROVISIONS; HEALTH CARE BENEFITS; BENEFIT MAXIMUMS,
19 INCLUDING BENEFIT LIMITATIONS; AND EXCLUSIONS OF COVERAGE;
20 (C) THE DEFINITION OF MEDICAL NECESSITY;
21 (D) THE CLINICAL PRACTICE GUIDELINES USED TO MAKE MEDICAL NECESSITY
22 AND UTILIZATION REVIEW DETERMINATIONS;
23 (E) PREVENTIVE CARE AND OTHER MEDICAL MANAGEMENT PRACTICES;
24 (F) DRUG FORMULARIES AND STANDARDS AND PROCEDURES FOR PRESCRIBING
25 OFF-FORMULARY DRUGS;
26 (G) RESPECTIVE PHYSICIAN LIABILITY FOR THE TREATMENT OR LACK OF TREAT-
27 MENT OF COVERED PERSONS;
28 (H) THE DETAILS OF HEALTH CARE PLAN RISK TRANSFER ARRANGEMENTS WITH
29 PROVIDERS;
30 (I) PLAN ADMINISTRATIVE PROCEDURES, INCLUDING METHODS AND TIMING OF
31 HEALTH CARE PROVIDER PAYMENT FOR SERVICES;
32 (J) PROCEDURES TO BE UTILIZED TO RESOLVE DISPUTES BETWEEN THE HEALTH
33 CARE PLAN AND HEALTH CARE PROVIDERS;
34 (K) PATIENT REFERRAL PROCEDURES INCLUDING, BUT NOT LIMITED TO, THOSE
35 APPLICABLE TO OUT-OF-POCKET NETWORK REFERRALS;
36 (L) THE FORMULATION AND APPLICATION OF HEALTH CARE PROVIDER REIMBURSE-
37 MENT PROCEDURES;
38 (M) QUALITY ASSURANCE PROGRAMS;
39 (N) THE PROCESS FOR RENDERING UTILIZATION REVIEW DETERMINATIONS
40 INCLUDING: ESTABLISHMENT OF A PROCESS FOR RENDERING UTILIZATION REVIEW
41 DETERMINATIONS WHICH SHALL, AT A MINIMUM, INCLUDE: WRITTEN PROCEDURES TO
42 ASSURE THAT UTILIZATION REVIEWS AND DETERMINATIONS ARE CONDUCTED WITHIN
43 THE TIMEFRAMES ESTABLISHED IN THIS ARTICLE; PROCEDURES TO NOTIFY AN
44 ENROLLEE, AN ENROLLEE'S DESIGNEE AND/OR AN ENROLLEE'S HEALTH CARE
45 PROVIDER OF ADVERSE DETERMINATIONS; AND PROCEDURES FOR APPEAL OF ADVERSE
46 DETERMINATIONS, INCLUDING THE ESTABLISHMENT OF AN EXPEDITED APPEALS
47 PROCESS FOR DENIALS OF CONTINUED INPATIENT CARE OR WHERE THERE IS IMMI-
48 NENT OR SERIOUS THREAT TO THE HEALTH OF THE ENROLLEE; AND
49 (O) HEALTH CARE PROVIDER SELECTION AND TERMINATION CRITERIA USED BY
50 THE HEALTH CARE PLAN.
51 2. NOTHING IN THIS SECTION SHALL BE CONSTRUED TO ALLOW OR AUTHORIZE AN
52 ALTERATION OF THE TERMS OF THE INTERNAL AND EXTERNAL REVIEW PROCEDURES
53 SET FORTH IN LAW.
54 3. NOTHING IN THIS SECTION SHALL BE CONSTRUED TO ALLOW A STRIKE OF A
55 HEALTH CARE PLAN BY HEALTH CARE PROVIDERS OR PLANS AS OTHERWISE SET
56 FORTH IN THE LAWS OF THIS STATE.
A. 3563 4
1 4. NOTHING IN THIS SECTION SHALL BE CONSTRUED TO ALLOW OR AUTHORIZE
2 TERMS OR CONDITIONS WHICH WOULD IMPEDE THE ABILITY OF A HEALTH CARE PLAN
3 TO OBTAIN OR RETAIN ACCREDITATION BY THE NATIONAL COMMITTEE FOR QUALITY
4 ASSURANCE OR A SIMILAR BODY.
5 S 4922. FEE RELATED COLLECTIVE NEGOTIATION. 1. IF THE HEALTH CARE PLAN
6 HAS SUBSTANTIAL MARKET SHARE IN A BUSINESS LINE IN THE DEMONSTRATION
7 SERVICE AREA, HEALTH CARE PROVIDERS PRACTICING WITHIN THE DEMONSTRATION
8 SERVICE AREA MAY COLLECTIVELY NEGOTIATE THE FOLLOWING TERMS AND CONDI-
9 TIONS RELATING TO THAT BUSINESS LINE WITH THE HEALTH CARE PLAN:
10 (A) THE FEES ASSESSED BY THE HEALTH CARE PLAN FOR SERVICES, INCLUDING
11 FEES ESTABLISHED THROUGH THE APPLICATION OF REIMBURSEMENT PROCEDURES;
12 (B) THE CONVERSION FACTORS USED BY THE HEALTH CARE PLAN IN A
13 RESOURCE-BASED RELATIVE VALUE SCALE REIMBURSEMENT METHODOLOGY OR OTHER
14 SIMILAR METHODOLOGY; PROVIDED THE SAME ARE NOT OTHERWISE ESTABLISHED BY
15 STATE OR FEDERAL LAW OR REGULATION;
16 (C) THE AMOUNT OF ANY DISCOUNT GRANTED BY THE HEALTH CARE PLAN ON THE
17 FEE OF HEALTH CARE SERVICES TO BE RENDERED BY HEALTH CARE PROVIDERS;
18 (D) THE DOLLAR AMOUNT OF CAPITATION OR FIXED PAYMENT FOR HEALTH
19 SERVICES RENDERED BY HEALTH CARE PROVIDERS TO HEALTH CARE PLAN ENROL-
20 LEES;
21 (E) THE PROCEDURE CODE OR OTHER DESCRIPTION OF A HEALTH CARE SERVICE
22 COVERED BY A PAYMENT AND THE APPROPRIATE GROUPING OF THE PROCEDURE
23 CODES; OR
24 (F) THE AMOUNT OF ANY OTHER COMPONENT OF THE REIMBURSEMENT METHODOLOGY
25 FOR A HEALTH CARE SERVICE.
26 2. NOTHING HEREIN SHALL BE DEEMED TO AFFECT OR LIMIT THE RIGHT OF A
27 HEALTH CARE PROVIDER OR GROUP OF HEALTH CARE PROVIDERS TO COLLECTIVELY
28 PETITION A GOVERNMENT ENTITY FOR A CHANGE IN A LAW, RULE, OR REGULATION.
29 S 4923. COLLECTIVE NEGOTIATION REQUIREMENTS. 1. COLLECTIVE NEGOTIATION
30 RIGHTS GRANTED BY THIS TITLE MUST CONFORM TO THE FOLLOWING REQUIREMENTS:
31 (A) HEALTH CARE PROVIDERS MAY COMMUNICATE WITH OTHER HEALTH CARE
32 PROVIDERS REGARDING THE CONTRACTUAL TERMS AND CONDITIONS TO BE NEGOTI-
33 ATED WITH A HEALTH CARE PLAN;
34 (B) HEALTH CARE PROVIDERS MAY COMMUNICATE WITH HEALTH CARE PROVIDERS'
35 REPRESENTATIVES;
36 (C) A HEALTH CARE PROVIDERS' REPRESENTATIVE IS THE ONLY PARTY AUTHOR-
37 IZED TO NEGOTIATE WITH HEALTH CARE PLANS ON BEHALF OF THE HEALTH CARE
38 PROVIDERS AS A GROUP;
39 (D) A HEALTH CARE PROVIDER CAN BE BOUND BY THE TERMS AND CONDITIONS
40 NEGOTIATED BY THE HEALTH CARE PROVIDERS' REPRESENTATIVES; AND
41 (E) IN COMMUNICATING OR NEGOTIATING WITH THE HEALTH CARE PROVIDERS'
42 REPRESENTATIVE, A HEALTH CARE PLAN IS ENTITLED TO CONTRACT WITH OR OFFER
43 DIFFERENT CONTRACT TERMS AND CONDITIONS TO INDIVIDUAL COMPETING HEALTH
44 CARE PROVIDERS.
45 2. A HEALTH CARE PROVIDERS' REPRESENTATIVE MAY NOT REPRESENT MORE THAN
46 THIRTY PERCENT OF THE MARKET OF HEALTH CARE PROVIDERS OR OF A PARTICULAR
47 HEALTH CARE PROVIDER TYPE OR SPECIALTY PRACTICING IN THE DEMONSTRATION
48 SERVICE AREA OR PROPOSED SERVICE AREA OF A HEALTH CARE PLAN THAT COVERS
49 LESS THAN FIVE PERCENT OF THE ACTUAL NUMBER OF COVERED LIVES OF THE
50 HEALTH CARE PLAN IN THE DEMONSTRATION SERVICE AREA, AS DETERMINED BY THE
51 DEPARTMENT.
52 3. NOTHING IN THIS SECTION SHALL BE CONSTRUED TO PROHIBIT COLLECTIVE
53 ACTION ON THE PART OF ANY HEALTH CARE PROVIDER WHO IS A MEMBER OF A
54 COLLECTIVE BARGAINING UNIT RECOGNIZED PURSUANT TO THE NATIONAL LABOR
55 RELATIONS ACT.
A. 3563 5
1 S 4924. REQUIREMENTS FOR HEALTH CARE PROVIDERS' REPRESENTATIVE. 1.
2 BEFORE ENGAGING IN COLLECTIVE NEGOTIATIONS WITH A HEALTH CARE PLAN ON
3 BEHALF OF HEALTH CARE PROVIDERS, A HEALTH CARE PROVIDERS' REPRESENTATIVE
4 SHALL FILE WITH THE COMMISSIONER, IN THE MANNER PRESCRIBED BY THE
5 COMMISSIONER, INFORMATION IDENTIFYING THE REPRESENTATIVE, THE REPRESEN-
6 TATIVE'S PLAN OF OPERATION, AND THE REPRESENTATIVE'S PROCEDURES TO
7 ENSURE COMPLIANCE WITH THIS TITLE.
8 2. BEFORE ENGAGING IN THE COLLECTIVE NEGOTIATIONS, THE HEALTH CARE
9 PROVIDERS' REPRESENTATIVE SHALL ALSO SUBMIT TO THE COMMISSIONER FOR THE
10 COMMISSIONER'S APPROVAL A REPORT IDENTIFYING THE PROPOSED SUBJECT MATTER
11 OF THE NEGOTIATIONS OR DISCUSSIONS WITH THE HEALTH CARE PLAN AND THE
12 EFFICIENCIES OR BENEFITS EXPECTED TO BE ACHIEVED THROUGH THE NEGOTI-
13 ATIONS FOR BOTH THE PROVIDERS AND CONSUMERS OF HEALTH SERVICES. THE
14 COMMISSIONER SHALL NOT APPROVE THE REPORT IF THE COMMISSIONER, IN
15 CONSULTATION WITH THE SUPERINTENDENT OF FINANCIAL SERVICES, DETERMINES
16 THAT THE PROPOSED NEGOTIATIONS WOULD EXCEED THE AUTHORITY GRANTED UNDER
17 THIS TITLE.
18 3. THE REPRESENTATIVE SHALL SUPPLEMENT THE INFORMATION IN THE REPORT
19 ON A REGULAR BASIS OR AS NEW INFORMATION BECOMES AVAILABLE, INDICATING
20 THAT THE SUBJECT MATTER OF THE NEGOTIATIONS WITH THE HEALTH CARE PLAN
21 HAS CHANGED OR WILL CHANGE. IN NO EVENT SHALL THE REPORT BE LESS THAN
22 EVERY THIRTY DAYS.
23 4. WITH THE ADVICE OF THE SUPERINTENDENT OF FINANCIAL SERVICES, THE
24 COMMISSIONER SHALL APPROVE OR DISAPPROVE THE REPORT NOT LATER THAN THE
25 TWENTIETH DAY AFTER THE DATE ON WHICH THE REPORT IS FILED. IF DISAP-
26 PROVED, THE COMMISSIONER SHALL FURNISH A WRITTEN EXPLANATION OF ANY
27 DEFICIENCIES, ALONG WITH A STATEMENT OF SPECIFIC PROPOSALS FOR REMEDIAL
28 MEASURES TO CURE THE DEFICIENCIES. IF THE COMMISSIONER DOES NOT SO ACT
29 WITHIN THE TWENTY DAYS, THE REPORT SHALL BE DEEMED APPROVED.
30 5. A PERSON WHO ACTS AS A HEALTH CARE PROVIDERS' REPRESENTATIVE WITH-
31 OUT THE APPROVAL OF THE COMMISSIONER UNDER THIS SECTION SHALL BE DEEMED
32 TO BE ACTING OUTSIDE THE AUTHORITY GRANTED UNDER THIS TITLE.
33 6. BEFORE REPORTING THE RESULTS OF NEGOTIATIONS WITH A HEALTH CARE
34 PLAN OR PROVIDING TO THE AFFECTED HEALTH CARE PROVIDERS AN EVALUATION OF
35 ANY OFFER MADE BY A HEALTH CARE PLAN, THE HEALTH CARE PROVIDERS' REPRE-
36 SENTATIVE SHALL FURNISH FOR APPROVAL BY THE COMMISSIONER, BEFORE DISSEM-
37 INATION TO THE HEALTH CARE PROVIDERS, A COPY OF ALL COMMUNICATIONS TO BE
38 MADE TO THE HEALTH CARE PROVIDERS RELATED TO NEGOTIATIONS, DISCUSSIONS,
39 AND OFFERS MADE BY THE HEALTH CARE PLAN.
40 7. A HEALTH CARE PROVIDERS' REPRESENTATIVE SHALL REPORT THE END OF
41 NEGOTIATIONS TO THE COMMISSIONER NOT LATER THAN THE FOURTEENTH DAY AFTER
42 THE DATE OF A HEALTH CARE PLAN DECISION DECLINING NEGOTIATION, CANCELING
43 NEGOTIATIONS, OR FAILING TO RESPOND TO A REQUEST FOR NEGOTIATION. IN
44 SUCH INSTANCES, A HEALTH CARE PROVIDERS' REPRESENTATIVE MAY REQUEST
45 INTERVENTION FROM THE COMMISSIONER TO REQUIRE THE HEALTH CARE PLAN TO
46 PARTICIPATE IN THE NEGOTIATION PURSUANT TO SUBDIVISION EIGHT OF THIS
47 SECTION.
48 8. (A) IN THE EVENT THE COMMISSIONER DETERMINES THAT AN IMPASSE EXISTS
49 IN THE NEGOTIATIONS, OR IN THE EVENT A HEALTH CARE PLAN DECLINES TO
50 NEGOTIATE, CANCELS NEGOTIATIONS OR FAILS TO RESPOND TO A REQUEST FOR
51 NEGOTIATION, THE COMMISSIONER SHALL RENDER ASSISTANCE AS FOLLOWS:
52 (1) TO ASSIST THE PARTIES TO EFFECT A VOLUNTARY RESOLUTION OF THE
53 NEGOTIATIONS, THE COMMISSIONER SHALL APPOINT A MEDIATOR FROM A LIST OF
54 QUALIFIED PERSONS MAINTAINED BY THE COMMISSIONER. IF THE MEDIATOR IS
55 SUCCESSFUL IN RESOLVING THE IMPASSE, THEN THE HEALTH CARE PROVIDERS'
56 REPRESENTATIVE SHALL PROCEED AS SET FORTH IN THIS ARTICLE;
A. 3563 6
1 (2) IF AN IMPASSE CONTINUES, THE COMMISSIONER SHALL APPOINT A
2 FACT-FINDING BOARD OF NOT MORE THAN THREE MEMBERS FROM A LIST OF QUALI-
3 FIED PERSONS MAINTAINED BY THE COMMISSIONER, WHICH FACT-FINDING BOARD
4 SHALL HAVE, IN ADDITION TO THE POWERS DELEGATED TO IT BY THE BOARD, THE
5 POWER TO MAKE RECOMMENDATIONS FOR THE RESOLUTION OF THE DISPUTE;
6 (B) THE FACT-FINDING BOARD, ACTING BY A MAJORITY OF ITS MEMBERS, SHALL
7 TRANSMIT ITS FINDINGS OF FACT AND RECOMMENDATIONS FOR RESOLUTION OF THE
8 DISPUTE TO THE COMMISSIONER, AND MAY THEREAFTER ASSIST THE PARTIES TO
9 EFFECT A VOLUNTARY RESOLUTION OF THE DISPUTE. THE FACT-FINDING BOARD
10 SHALL ALSO SHARE ITS FINDINGS OF FACT AND RECOMMENDATIONS WITH THE
11 HEALTH CARE PROVIDERS' REPRESENTATIVE AND THE HEALTH CARE PLAN. IF WITH-
12 IN TWENTY DAYS AFTER THE SUBMISSION OF THE FINDINGS OF FACT AND RECOM-
13 MENDATIONS, THE IMPASSE CONTINUES, THE COMMISSIONER SHALL ORDER A RESOL-
14 UTION TO THE NEGOTIATIONS BASED UPON THE FINDINGS OF FACT AND
15 RECOMMENDATIONS SUBMITTED BY THE FACT-FINDING BOARD.
16 9. ANY PROPOSED AGREEMENT BETWEEN HEALTH CARE PROVIDERS AND A HEALTH
17 CARE PLAN NEGOTIATED PURSUANT TO THIS TITLE SHALL BE SUBMITTED TO THE
18 COMMISSIONER FOR FINAL APPROVAL. THE COMMISSIONER SHALL APPROVE OR
19 DISAPPROVE THE AGREEMENT WITHIN SIXTY DAYS OF SUCH SUBMISSION. THE
20 COMMISSIONER, AFTER CONSULTATION WITH THE SUPERINTENDENT OF FINANCIAL
21 SERVICES SHALL DISAPPROVE THE AGREEMENT IF HE OR SHE FINDS THAT THE
22 AGREEMENT WOULD RESULT IN A SIGNIFICANT INCREASE IN COSTS TO THE MEDI-
23 CAID MANAGED CARE PROGRAM PURSUANT TO SECTION THREE HUNDRED SIXTY-FOUR-J
24 OF THE SOCIAL SERVICES LAW, THE FAMILY HEALTH PLUS PROGRAM PURSUANT TO
25 SECTION THREE HUNDRED SIXTY-NINE-EE OF THE SOCIAL SERVICES LAW, OR THE
26 CHILD HEALTH PLUS PROGRAM PURSUANT TO SECTION TWENTY-FIVE HUNDRED ELEVEN
27 OF THE PUBLIC HEALTH LAW.
28 10. THE COMMISSIONER MAY COLLECT INFORMATION FROM THE DEPARTMENT OF
29 FINANCIAL SERVICES AND OTHER PERSONS TO ASSIST IN EVALUATING THE IMPACT
30 OF THE PROPOSED ARRANGEMENT ON THE HEALTH CARE MARKETPLACE. THE COMMIS-
31 SIONER SHALL COLLECT INFORMATION FROM HEALTH PLAN COMPANIES AND HEALTH
32 CARE PROVIDERS OPERATING IN THE SAME GEOGRAPHIC AREA AS THE HEALTH CARE
33 COOPERATIVE.
34 S 4925. CERTAIN COLLECTIVE ACTION PROHIBITED. 1. THIS TITLE IS NOT
35 INTENDED TO AUTHORIZE COMPETING HEALTH CARE PROVIDERS TO ACT IN CONCERT
36 IN RESPONSE TO A REPORT ISSUED BY THE HEALTH CARE PROVIDERS' REPRESEN-
37 TATIVE RELATED TO THE REPRESENTATIVE'S DISCUSSIONS OR NEGOTIATIONS WITH
38 HEALTH CARE PLANS.
39 2. NO HEALTH CARE PROVIDERS' REPRESENTATIVE SHALL NEGOTIATE ANY AGREE-
40 MENT THAT EXCLUDES, LIMITS THE PARTICIPATION OR REIMBURSEMENT OF, OR
41 OTHERWISE LIMITS THE SCOPE OF SERVICES TO BE PROVIDED BY ANY HEALTH CARE
42 PROVIDER OR GROUP OF HEALTH CARE PROVIDERS WITH RESPECT TO THE PERFORM-
43 ANCE OF SERVICES THAT ARE WITHIN THE HEALTH CARE PROVIDER'S SCOPE OF
44 PRACTICE, LICENSE, REGISTRATION, OR CERTIFICATE.
45 S 4926. FEES. EACH PERSON WHO ACTS AS THE REPRESENTATIVE OR NEGOTIAT-
46 ING PARTIES UNDER THIS TITLE SHALL PAY TO THE DEPARTMENT A FEE TO ACT AS
47 A REPRESENTATIVE. THE COMMISSIONER, BY RULE, SHALL SET FEES IN AMOUNTS
48 DEEMED REASONABLE AND NECESSARY TO COVER THE COSTS INCURRED BY THE
49 DEPARTMENT IN ADMINISTERING THIS TITLE. ANY FEE COLLECTED UNDER THIS
50 SECTION SHALL BE DEPOSITED IN THE STATE TREASURY TO THE CREDIT OF THE
51 GENERAL FUND/STATE OPERATIONS FOR THE NEW YORK STATE DEPARTMENT OF
52 HEALTH FUND.
53 S 4927. MONITORING OF AGREEMENTS. THE COMMISSIONER SHALL ACTIVELY
54 MONITOR AGREEMENTS APPROVED UNDER THIS TITLE TO ENSURE THAT THE AGREE-
55 MENT REMAINS IN COMPLIANCE WITH THE CONDITIONS OF APPROVAL. UPON
56 REQUEST, A HEALTH CARE PLAN OR HEALTH CARE PROVIDER SHALL PROVIDE INFOR-
A. 3563 7
1 MATION REGARDING COMPLIANCE. THE COMMISSIONER MAY REVOKE AN APPROVAL
2 UPON A FINDING THAT THE AGREEMENT IS NOT IN SUBSTANTIAL COMPLIANCE WITH
3 THE TERMS OF THE APPLICATION OR THE CONDITIONS OF APPROVAL.
4 S 4928. CONFIDENTIALITY. ALL REPORTS AND OTHER INFORMATION REQUIRED TO
5 BE REPORTED TO THE DEPARTMENT UNDER THIS TITLE INCLUDING INFORMATION
6 OBTAINED BY THE COMMISSIONER PURSUANT TO SUBDIVISION TEN OF SECTION
7 FORTY-NINE HUNDRED TWENTY-FOUR OF THIS TITLE SHALL NOT BE SUBJECT TO
8 DISCLOSURE UNDER ARTICLE SIX OF THE PUBLIC OFFICERS LAW OR ARTICLE THIR-
9 TY-ONE OF THE CIVIL PRACTICE LAW AND RULES.
10 S 4929. SEVERABILITY AND CONSTRUCTION. THE PROVISIONS OF THIS TITLE
11 SHALL BE SEVERABLE, AND IF ANY COURT OF COMPETENT JURISDICTION DECLARES
12 ANY PHRASE, CLAUSE, SENTENCE OR PROVISION OF THIS TITLE TO BE INVALID,
13 OR ITS APPLICABILITY TO ANY GOVERNMENT, AGENCY, PERSON OR CIRCUMSTANCE
14 IS DECLARED INVALID, THE REMAINDER OF THIS TITLE AND ITS RELEVANT APPLI-
15 CABILITY SHALL NOT BE AFFECTED. THE PROVISIONS OF THIS TITLE SHALL BE
16 LIBERALLY CONSTRUED TO GIVE EFFECT TO THE PURPOSES THEREOF.
17 S 4. The department of health, in consultation with the department of
18 financial services, shall prepare or shall arrange for the preparation
19 of a report on the implementation of the demonstration program on
20 collective negotiation. The report shall be submitted to the governor,
21 the speaker of the assembly, the temporary president of the senate and
22 the chairs of the senate and assembly health and insurance committees at
23 least four months prior to the expiration of this act. The report shall
24 review the extent to which collective negotiations were conducted in the
25 demonstration service area and shall examine whether and the extent to
26 which collective negotiation contributed to the improvement of quality
27 of care for patients, enhanced access to medically necessary care,
28 reduced unnecessary health care expenditures, and was otherwise in the
29 public interest. The report may make recommendations regarding the
30 extension, alteration and/or expansion of these provisions and make any
31 other recommendations related to the implementation of collective nego-
32 tiation pursuant to this act.
33 S 5. This act shall take effect on the one hundred twentieth day after
34 it shall have become a law and shall expire and be deemed repealed three
35 years after it shall take effect; provided that the commissioner of
36 health is authorized to promulgate any and all rules and regulations and
37 take any other measures necessary to implement this act on its effective
38 date on or before such date.