Section 4325. Prohibitions

(a) No corporation organized under this article
  shall by contract, written  policy  or  written  procedure  prohibit  or
  restrict  any  health  care  provider from disclosing to any subscriber,
  designated representative or, where appropriate, prospective subscriber,
  (hereinafter collectively referred to  as  subscriber)  any  information
  that such provider deems appropriate regarding:
    (1)  a  condition or a course of treatment with a subscriber including
  the availability of other therapies, consultations, or tests; or
    (2) the  provisions,  terms,  or  requirements  of  the  corporation's
  products as they relate to the subscriber.
    (b)  No  corporation  organized  under 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 corporation which the provider believes may negatively impact  upon
  the quality of or access to patient care.
    (c)  No  corporation  organized  under this article shall by contract,
  written policy or written procedure prohibit or restrict any health care
  provider from advocating to the corporation on behalf of the  subscriber
  for approval or coverage of a particular course of treatment.
    (d)  No  contract  or  agreement between a corporation organized under
  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 corporation 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 rates 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 contract 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  a  corporation  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 subscribers 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  corporation  provides notice to the subscriber 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  a  corporation  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 subscribers 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  corporation  provides notice to the subscriber at least thirty days
  in advance of the date of contract termination.
    * NB Effective January 1, 2010
    * NB Repealed June 30, 2011