2006 New York Code - Health Care Professional Applications And Terminations.

 
    § 4406-d. Health care professional applications and terminations. 1. A
  health  care  plan  shall,  upon request, make available and disclose to
  health care professionals written  application  procedures  and  minimum
  qualification requirements which a health care professional must meet in
  order  to  be considered by the health care plan. The plan shall consult
  with appropriately qualified health care professionals in developing its
  qualification requirements.
    2. (a) A health care plan shall not terminate a contract with a health
  care professional unless the health care plan  provides  to  the  health
  care  professional a written explanation of the reasons for the proposed
  contract termination and an opportunity  for  a  review  or  hearing  as
  hereinafter  provided.   This section shall not apply in cases involving
  imminent harm to patient care, a determination  of  fraud,  or  a  final
  disciplinary  action  by  a  state licensing board or other governmental
  agency that impairs the health care professional's ability to practice.
    (b) The notice of the proposed contract termination  provided  by  the
  health care plan to the health care professional shall include:
    (i) the reasons for the proposed action;
    (ii) notice that the health care professional has the right to request
  a  hearing  or  review, at the professional's discretion, before a panel
  appointed by the health care plan;
    (iii) a time limit of not less than thirty days within which a  health
  care professional may request a hearing; and
    (iv)  a time limit for a hearing date which must be held within thirty
  days after the date of receipt of a request for a hearing.
    (c) The hearing panel shall be comprised of three persons appointed by
  the health care plan. At least one person  on  such  panel  shall  be  a
  clinical  peer  in the same discipline and the same or similar specialty
  as the health care professional under  review.  The  hearing  panel  may
  consist  of more than three persons, provided however that the number of
  clinical peers on such panel shall constitute one-third or more  of  the
  total membership of the panel.
    (d)  The  hearing panel shall render a decision on the proposed action
  in a timely manner. Such decision shall  include  reinstatement  of  the
  health   care   professional   by  the  health  care  plan,  provisional
  reinstatement subject to conditions set forth by the health care plan or
  termination of the health care  professional.  Such  decision  shall  be
  provided in writing to the health care professional.
    (e)  A  decision  by  the  hearing  panel  to  terminate a health care
  professional shall be effective not less  than  thirty  days  after  the
  receipt by the health care professional of the hearing panel's decision;
  provided,  however,  that the provisions of paragraph (e) of subdivision
  six of section four thousand four hundred three of  this  article  shall
  apply to such termination.
    (f) In no event shall termination be effective earlier than sixty days
  from the receipt of the notice of termination.
    3.  Either  party to a contract may exercise a right of non-renewal at
  the expiration of the contract  period  set  forth  therein  or,  for  a
  contract  without  a  specific  expiration  date,  on each January first
  occurring after the contract has been in effect for at least  one  year,
  upon  sixty  days notice to the other party; provided, however, that any
  non-renewal shall not constitute a  termination  for  purposes  of  this
  section.
    4.  A  health  care  plan  shall  develop  and  implement policies and
  procedures to  ensure  that  health  care  professionals  are  regularly
  informed  of  information maintained by the health care plan to evaluate
  the performance or practice of the health care professional. The  health
  care  plan  shall  consult  with health care professionals in developing
  methodologies to collect and analyze health care professional  profiling
  data. Health care plans shall provide any such information and profiling
  data  and  analysis to health care professionals. Such information, data
  or  analysis  shall  be  provided on a periodic basis appropriate to the
  nature and amount of data and the volume and scope of services provided.
  Any profiling data used to evaluate the performance  or  practice  of  a
  health  care  professional shall be measured against stated criteria and
  an  appropriate  group  of  health  care  professionals  using   similar
  treatment  modalities  serving  a  comparable  patient  population. Upon
  presentation of such information or data, each health care  professional
  shall  be  given  the  opportunity  to  discuss the unique nature of the
  health care professional's patient population which may have  a  bearing
  on the health care professional's profile and to work cooperatively with
  the health care plan to improve performance.
    5.  No  health  care plan shall terminate a contract or employment, or
  refuse to renew a contract, solely because a health care provider has:
    (a) advocated on behalf of an enrollee;
    (b) filed a complaint against the health care plan;
    (c) appealed a decision of the health care plan;
    (d) provided  information  or  filed  a  report  pursuant  to  section
  forty-four hundred six-c of this article; or
    (e) requested a hearing or review pursuant to this section.
    6.  Except  as  provided  herein,  no  contract or agreement between a
  health care plan and  a  health  care  professional  shall  contain  any
  provision  which  shall supersede or impair a health care professional's
  right to notice of reasons for termination and  the  opportunity  for  a
  hearing or review concerning such termination.
    7. Any contract provision in violation of this section shall be deemed
  to be void and unenforceable.
    8.  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.
    9. For purposes of this section, "health care professional" shall mean
  a health care professional licensed, registered or certified pursuant to
  title eight of the education law.