S 1911: Relates to notices of non-renewal provided to a health care professional by a health care plan - New York

S1911B → S1911C · 5 edits

MODERATE

The bill was amended to shift its focus from preventing the termination of health care professionals to regulating the process of non-renewal of contracts. The changes remove specific procedural rights for hearings and panels that were previously available to professionals facing termination, replacing them with a streamlined notice process that allows both parties to non-renew contracts with 60 days' notice. The bill now explicitly lists acceptable reasons for non-renewal, such as reimbursement rates and utilization, and requires the plan to provide instructions on how the professional can respond to the rationale for non-renewal.

Scope change

The bill's scope narrowed from covering both contract terminations and non-renewals to focusing exclusively on non-renewals, and it was expanded to apply to insurers' in-network contracts in addition to health care plans.

REQUIREMENT

Removed the requirement for a formal hearing panel and the right to request a review or hearing before a panel appointed by the health care plan.

Changed the subject from preventing 'termination' to regulating 'non-renewal' of contracts, allowing either party to end the agreement.

Added specific examples of valid reasons for non-renewal, including reimbursement rates, quality of care, and utilization rates.

Added a requirement for the notice to include instructions on how the professional can submit information to respond to the non-renewal rationale.

SCOPE

Extended the application of these non-renewal rules to include contracts for participation in an insurer's in-network benefits portion of a managed care product.

S1911A → S1911B · 3 edits

MINOR

This bill version adds a new sponsor, Webb, and updates the legislative history to reflect committee reports and third reading orders. The core policy text regarding hearing panels and termination protections remains largely the same, though the description of the hearing panel composition was simplified by removing specific details about how the third member is selected. A new provision was added to explicitly prohibit terminating a provider solely for advocating on behalf of patients or filing complaints against the plan.

Scope change

The bill's scope of applicability to health care professionals and plans remains unchanged, but the legislative process status has advanced.

TECHNICAL

Added Senator Webb as a co-sponsor and updated the header to reflect committee discharge, favorable report, and third reading orders.

REQUIREMENT

Simplified the description of the hearing panel composition by removing specific rules about how the third panel member is chosen.

Added a new protection prohibiting health care plans from terminating or refusing to renew a provider solely because the provider advocated for a patient or filed a complaint against the plan.

S1911 → S1911A · 5 edits

MODERATE

The bill was amended to replace a voluntary mediation process with a mandatory hearing and review system for health care professionals facing contract termination or non-renewal. The changes require health care plans to provide specific written reasons for proposed actions, establish a three-person hearing panel with balanced representation, and set strict timelines for decisions and effective dates of termination.

Scope change

The bill's scope expanded from focusing on hospitals and insurers to explicitly include health care plans, and it broadened the types of contracts and entities covered under the new review procedures.

REQUIREMENT

Replaced optional mediation with a mandatory hearing process where professionals can request a review by a licensed panel before termination takes effect.

Required health care plans to provide written explanations detailing the specific reasons for proposed contract terminations or non-renewals.

Mandated that hearing panels consist of three members with a specific balance: one appointed by the plan, one by the professional, and one chosen by the other two, ensuring clinical peer review.

Added new provisions requiring health care plans to develop policies for regularly informing professionals of their performance data and profiling metrics.

TIMELINE

Established a 30-day window for requesting a hearing and required the panel to render a decision within 30 days of that request.

Relates to notices of non-renewal provided to a health care professional by a health care plan

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