2006 New York Code - Prohibitions.

 
    §  4406-c. Prohibitions. 1. For purposes of this section, "health care
  plan" shall mean a health maintenance organization licensed pursuant  to
  article  forty-three  of the insurance law or certified pursuant to this
  article or an independent practice association certified  or  recognized
  pursuant to this article or a medical group.
    2.  No health care plan shall by contract or written policy or written
  procedure prohibit or restrict any health care provider from  disclosing
  to  any  subscriber,  enrollee,  patient,  designated representative or,
  where  appropriate,  prospective  enrollee,  (hereinafter   collectively
  referred  to  as  enrollee)  any  information  that  such provider deems
  appropriate regarding:
    (a) a condition or a course of treatment with  an  enrollee  including
  the availability of other therapies, consultations, or tests; or
    (b)  the  provisions, terms, or requirements of the health care plan's
  products as they relate to the enrollee, where applicable.
    3. No health care plan 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 health care plan which
  the provider believes may negatively impact  upon  the  quality  of,  or
  access to, patient care.
    4.  No  health  care plan shall by contract, written policy or written
  procedure prohibit or restrict any health care provider from  advocating
  to  the  health  care  plan  on  behalf  of the enrollee for approval or
  coverage of a particular course of treatment or  for  the  provision  of
  health care services.
    5.  No  contract  or agreement between a health care plan and a health
  care provider shall contain any clause purporting  to  transfer  to  the
  health  care provider, other than a medical group, by indemnification or
  otherwise any liability relating to activities, actions or omissions  of
  the health care plan as opposed to those of the health care provider.
    5-a.  Contracts entered into between a plan and a health care provider
  shall include terms which prescribe:
    (a) the  method  by  which  payments  to  a  provider,  including  any
  prospective or retrospective adjustments thereto, shall be calculated;
    (b) 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;
    (c)  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;
    (d)  the  process  to  be  employed  to resolved 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 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
    (e)  the right of either party to the contract to seek resolution of a
  dispute arising pursuant to the payment terms of such contract through a
  proceeding under article seventy-five of  the  civil  practice  law  and
  rules.
    5-b.  No  contract  entered  into  with health care providers 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 this article,
  or  penalize  providers for unfavorable case mix so as to jeopardize the
  quality of or  enrollees'  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.
    6.  Any  contract  provision,  written  policy or written procedure in
  violation of this section shall be deemed to be void and unenforceable.