S 7913: Relates to improper practices relating to staff membership or professional privileges of a physician and such physician's board certification.

  
  STATE OF NEW YORK ________________________________________________________________________ 7913 2025-2026 Regular Sessions  IN SENATE May 13, 2025 ___________ Introduced by Sen. RIVERA -- read twice and ordered printed, and when printed to be committed to the Committee on Health 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 Assem- bly, do enact as follows: 1 Section 1. Subdivision 1 of section 2801-b of the public health law, 2 as amended by chapter 605 of the laws of 2008, is amended to read as 3 follows: 4 1. It shall be an improper practice for the governing body of a hospi- 5 tal to refuse to act upon an application for staff membership or profes- 6 sional privileges or to deny or withhold from a physician, podiatrist, 7 optometrist, dentist or licensed midwife staff membership or profes- 8 sional privileges in a hospital, or to exclude or expel a physician, 9 podiatrist, optometrist, dentist or licensed midwife from staff member- 10 ship in a hospital or curtail, terminate or diminish in any way a physi- 11 cian's, podiatrist's, optometrist's, dentist's or licensed midwife's 12 professional privileges in a hospital, without stating the reasons 13 therefor, or if the reasons stated are unrelated to standards of patient 14 care, patient welfare, the objectives of the institution or the charac- 15 ter or competency of the applicant. It shall be an improper practice for 16 a governing body of a hospital to refuse to act upon an application or 17 to deny or to withhold staff membership or professional privileges to a 18 physician, podiatrist, optometrist, dentist, or licensed midwife based 19 solely upon a practitioner's category of licensure. It shall be an 20 improper practice for a governing body of a hospital to refuse to act 21 upon an application or to deny or to withhold staff membership or 22 professional privileges of a physician who was previously board-certi- 23 fied and who has not maintained such certification solely because such 24 physician is not board-certified. EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD11839-01-5 
 S. 7913 2 1 § 2. Paragraph (a) of subdivision 1 of section 4406-d of the public 2 health law, as amended by chapter 425 of the laws of 2016, is amended to 3 read as follows: 4 (a) A health care plan shall, upon request, make available and 5 disclose to health care professionals written application procedures and 6 minimum qualification requirements which a health care professional must 7 meet in order to be considered by the health care plan. The plan shall 8 consult with appropriately qualified health care professionals in devel- 9 oping its qualification requirements. A health care plan shall complete 10 review of the health care professional's application to participate in 11 the in-network portion of the health care plan's network and shall, 12 within sixty days of receiving a health care professional's completed 13 application to participate in the health care plan's network, notify the 14 health care professional as to: (i) whether [he or she] such health care 15 professional is credentialed; or (ii) whether additional time is neces- 16 sary to make a determination because of a failure of a third party to 17 provide necessary documentation. In such instances where additional time 18 is necessary because of a lack of necessary documentation, a health plan 19 shall make every effort to obtain such information as soon as possible 20 and shall make a final determination within twenty-one days of receiving 21 the necessary documentation. A health care plan may not refuse to 22 approve an application from a physician, who was previously board-certi- 23 fied and who has not maintained such certification, to participate in 24 the in-network portion of the health care plan's network solely because 25 such physician is not board-certified. 26 § 3. Paragraph 1 of subsection (a) of section 4803 of the insurance 27 law, as amended by chapter 425 of the laws of 2016, is amended to read 28 as follows: 29 (1) An insurer which offers a managed care product shall, upon 30 request, make available and disclose to health care professionals writ- 31 ten application procedures and minimum qualification requirements which 32 a health care professional must meet in order to be considered by the 33 insurer for participation in the in-network benefits portion of the 34 insurer's network for the managed care product. The insurer shall 35 consult with appropriately qualified health care professionals in devel- 36 oping its qualification requirements for participation in the in-network 37 benefits portion of the insurer's network for the managed care product. 38 An insurer shall complete review of the health care professional's 39 application to participate in the in-network portion of the insurer's 40 network and, within sixty days of receiving a health care professional's 41 completed application to participate in the insurer's network, will 42 notify the health care professional as to: (A) whether [he or she] such 43 health care professional is credentialed; or (B) whether additional time 44 is necessary to make a determination because of a failure of a third 45 party to provide necessary documentation. In such instances where addi- 46 tional time is necessary because of a lack of necessary documentation, 47 an insurer shall make every effort to obtain such information as soon as 48 possible and shall make a final determination within twenty-one days of 49 receiving the necessary documentation. An insurer may not refuse to 50 approve an application from a physician, who was previously board-certi- 51 fied and who has not maintained such certification, for participation in 52 the in-network portion of the insurer's network solely because such 53 physician is not board-certified. 54 § 4. This act shall take effect immediately.