Section 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)  Any  contract provision, written policy or written procedure in
  violation of this section shall be deemed to be void and unenforceable.
    * NB Effective until January 1, 2010
    * (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.
    * NB Effective January 1, 2010
    * (h)  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 Effective until January 1, 2010
    * (h)  Any  contract provision, written policy or written procedure in
  violation of this section shall be deemed to be void and unenforceable.
    * NB Effective January 1, 2010
    * (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 Effective January 1, 2010
    * NB Repealed June 30, 2011