2010 New York Code
ISC - Insurance
Article 32 - (3201 - 3239) INSURANCE CONTRACTS - LIFE, ACCIDENT AND HEALTH, ANNUITIES
3217-B - Prohibitions.

§  3217-b.  Prohibitions. (a) No insurer subject to this article shall
  by contract, written policy or written procedure  prohibit  or  restrict
  any  health  care  provider  from  disclosing to any insured, designated
  representative or, where appropriate, prospective insured,  (hereinafter
  collectively  referred to as insured) any information that such provider
  deems appropriate regarding:
    (1) a condition or a course of treatment with an insured including the
  availability of other therapies, consultations, or tests; or
    (2) the provisions, terms, or requirements of the  insurer's  products
  as they relate to the insured.
    (b)  No  insurer  subject  to  this article shall by contract, written
  policy or  written  procedure  prohibit  or  restrict  any  health  care
  provider  from  filing  a complaint, making a report or commenting to an
  appropriate governmental body regarding the  policies  or  practices  of
  such  insurer which the provider believes may negatively impact upon the
  quality of, or access to, patient care.
    (c) No insurer subject to this  article  shall  by  contract,  written
  policy  or  written  procedure  prohibit  or  restrict  any  health care
  provider from advocating to the insurer on behalf  of  the  insured  for
  approval  or  coverage  of  a  particular course of treatment or for the
  provision of health care services.
    (d) No contract or  agreement  between  an  insurer  subject  to  this
  article  and  a health care provider shall contain any clause purporting
  to transfer to the health care provider by indemnification or  otherwise
  any  liability  relating  to  activities,  actions  or  omissions of the
  insurer as opposed to the health care provider.
    (e) Contracts entered into  between  an  insurer  and  a  health  care
  provider shall include terms which prescribe:
    (1)  the  method  by  which  payments  to  a  provider,  including any
  prospective or retrospective adjustments thereto, shall be calculated;
    (2) the time periods within which such calculations will be completed,
  the dates  upon  which  any  such  payments  and  adjustments  shall  be
  determined  to  be  due,  and the dates upon which any such payments and
  adjustments will be made;
    (3) a description  of  the  records  or  information  relied  upon  to
  calculate  any  such  payments and adjustments, and a description of how
  the provider can access a summary of such calculations and adjustments;
    (4) the process to  be  employed  to  resolve  disputed  incorrect  or
  incomplete  records  or  information and to adjust any such payments and
  adjustments which have been calculated by relying on any such  incorrect
  or  incomplete  records  or  information so disputed; provided, however,
  that nothing  herein  shall  be  deemed  to  authorize  or  require  the
  disclosure of personally identifiable patient information or information
  related  to  other  individual  health  care  providers  or  the  plan's
  proprietary data collection systems, software or  quality  assurance  or
  utilization review methodologies; and
    (5)  the right of either party to the contract to seek resolution of a
  dispute arising pursuant to the payment terms of such contracts  through
  a  proceeding  under  article seventy-five of the civil practice law and
  rules.
    (f) No contract entered into between an  insurer  and  a  health  care
  provider  shall  be  enforceable  if  it  includes  terms which transfer
  financial  risk  to  providers,  in  a  manner  inconsistent  with   the
  provisions  of  paragraph  (c)  of subdivision one of section forty-four
  hundred three of the  public  health  law,  or  penalize  providers  for
  unfavorable  case  mix  so  as to jeopardize the quality of or insureds'
  appropriate access to medically necessary services;  provided,  however,
  that payment at less than prevailing fee for service rates or capitation

shall  not  be  deemed  or presumed prima facie to jeopardize quality or
  access.
    (g)(1) No insurer shall implement an adverse reimbursement change to a
  contract  with a health care professional that is otherwise permitted by
  the contract, unless, prior to the effective date  of  the  change,  the
  insurer  gives  the  health  care professional with whom the insurer has
  directly contracted and who is impacted  by  the  adverse  reimbursement
  change,  at  least  ninety  days  written  notice  of the change. If the
  contracting health care professional objects to the change that  is  the
  subject  of the notice by the insurer, the health care professional may,
  within thirty days of the date of the notice, give written notice to the
  insurer to terminate his or her contract with the insurer effective upon
  the implementation date of the adverse  reimbursement  change.  For  the
  purposes  of  this  subsection,  the term "adverse reimbursement change"
  shall mean a proposed change that could reasonably be expected to have a
  material adverse impact on the aggregate level of payment  to  a  health
  care  professional, and the term "health care professional" shall mean a
  health care professional licensed, registered or certified  pursuant  to
  title eight of the education law. The notice provisions required by this
  subsection  shall not apply where: (A) such change is otherwise required
  by law, regulation or applicable regulatory authority, or is required as
  a result of changes  in  fee  schedules,  reimbursement  methodology  or
  payment  policies  established by a government agency or by the American
  Medical  Association's  current  procedural  terminology  (CPT)   codes,
  reporting  guidelines  and  conventions; or (B) such change is expressly
  provided for under the terms of the contract  by  the  inclusion  of  or
  reference  to  a specific fee or fee schedule, reimbursement methodology
  or payment policy indexing mechanism.
    (2) Nothing in this subsection shall create a private right of  action
  on  behalf  of  a  health  care  professional  against  an  insurer  for
  violations of this subsection.
    (h) Any contract provision, written policy  or  written  procedure  in
  violation of this section shall be deemed to be void and unenforceable.
    * (i)  If  a contract between an insurer and a hospital is not renewed
  or is terminated by either party, the parties shall continue to abide by
  the terms of such contract, including reimbursement terms, for a  period
  of  two months from the effective date of termination or, in the case of
  a non-renewal, from the end of the  contract  period.  Notice  shall  be
  provided  to  all  insureds  potentially affected by such termination or
  non-renewal within fifteen days  after  commencement  of  the  two-month
  period. The commissioner of health shall have the authority to waive the
  two-month  period upon the request of either party to a contract that is
  being terminated for cause. This subsection shall not apply  where  both
  parties  mutually agree in writing to the termination or non-renewal and
  the insurer provides notice to the  insured  at  least  thirty  days  in
  advance of the date of contract termination.
    * NB Repealed June 30, 2011