STATE OF NEW YORK
________________________________________________________________________
8844
IN SENATE
July 29, 2020
___________
Introduced by Sen. BENJAMIN -- read twice and ordered printed, and when
printed to be committed to the Committee on Rules
AN ACT to amend the public health law and the insurance law, in relation
to the definition of clinical peer reviewer
The People of the State of New York, represented in Senate and Assem-
bly, do enact as follows:
1 Section 1. Subdivision 2 of section 4900 of the public health law, as
2 amended by chapter 586 of the laws of 1998, item (B) of subparagraph
3 (ii) of paragraph (a) as amended by chapter 41 of the laws of 2014 and
4 subparagraph (iii) as amended and subparagraph (iv) of paragraph (a) as
5 added by section 42 of subpart A of part BB of chapter 57 of the laws of
6 2019, is amended to read as follows:
7 2. "Clinical peer reviewer" means:
8 (a) [for purposes of title one of this article:
9 (i) a physician who possesses a current and valid non-restricted
10 license to practice medicine; or
11 (ii) a health care professional other than a licensed physician who:
12 (A) where applicable, possesses a current and valid non-restricted
13 license, certificate or registration or, where no provision for a
14 license, certificate or registration exists, is credentialed by the
15 national accrediting body appropriate to the profession; and
16 (B) is in the same profession and same or similar specialty as the
17 health care provider who typically manages the medical condition or
18 disease or provides the health care service or treatment under review;
19 or
20 (iii) for purposes of a determination involving substance use disorder
21 treatment:
22 (A) a physician who possesses a current and valid non-restricted
23 license to practice medicine and who specializes in behavioral health
24 and has experience in the delivery of substance use disorder courses of
25 treatment; or
26 (B) a health care professional other than a licensed physician who
27 specializes in behavioral health and has experience in the delivery of
28 substance use disorder courses of treatment and, where applicable,
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD03373-04-0
S. 8844 2
1 possesses a current and valid non-restricted license, certificate or
2 registration or, where no provision for a license, certificate or regis-
3 tration exists, is credentialed by the national accrediting body appro-
4 priate to the profession; or
5 (iv) for purposes of a determination involving treatment for a mental
6 health condition:
7 (A) a physician who possesses a current and valid non-restricted
8 license to practice medicine and who specializes in behavioral health
9 and has experience in the delivery of mental health courses of treat-
10 ment; or
11 (B) a health care professional other than a licensed physician who
12 specializes in behavioral health and has experience in the delivery of a
13 mental health courses of treatment and, where applicable, possesses a
14 current and valid non-restricted license, certificate, or registration
15 or, where no provision for a license, certificate or registration
16 exists, is credentialed by the national accrediting body appropriate to
17 the profession; and
18 (b) for purposes of title two of this article:
19 (i)] a physician who:
20 [(A)] (i) possesses a current and valid non-restricted license to
21 practice medicine under article one hundred thirty-one of the education
22 law;
23 [(B)] (ii) where applicable, is board certified or board eligible in
24 the same or similar specialty as the health care provider who typically
25 manages the medical condition or disease or provides the health care
26 service or treatment under review or appeal;
27 [(C)] (iii) has been practicing in such area of specialty for a period
28 of at least five years; [and]
29 (iv) for purposes of a determination involving substance use disorder
30 treatment, possesses a current and valid non-restricted license to prac-
31 tice medicine and specializes in behavioral health and has experience in
32 the delivery of substance use disorder courses of treatment;
33 (v) for purposes of a determination involving treatment for a mental
34 health condition, possesses a current and valid non-restricted license
35 to practice medicine and who specializes in behavioral health and has
36 experience in the delivery of mental health courses of treatment; and
37 [(D)] (vi) is knowledgeable about the health care service or treatment
38 under review or appeal; or
39 [(ii)] (b) a health care professional other than a licensed physician
40 who possesses a current and valid non-restricted license or certif-
41 ication under title eight of the education law:
42 [(A)] (i) where applicable, possesses a current and valid non-res-
43 tricted license, certificate or registration;
44 [(B)] (ii) where applicable, is credentialed by the national accredit-
45 ing body appropriate to the profession in the same profession and same
46 or similar specialty as the health care provider who typically manages
47 the medical condition or disease or provides the health care service or
48 treatment under review or appeal;
49 [(C)] (iii) has been practicing in such area of specialty for a period
50 of at least five years;
51 [(D)] (iv) is knowledgeable about the health care service or treatment
52 under review or appeal; [and]
53 (v) for purposes of a determination involving substance use disorder,
54 specializes in behavioral health and has experience in the delivery of
55 substance use disorder courses of treatment and, where applicable,
56 possesses a current and valid non-restricted license, certificate or
S. 8844 3
1 registration or, where no provision for a license, certificate or regis-
2 tration exists, is credentialed by the national accrediting body appro-
3 priate to the profession;
4 (vi) for purposes of a determination involving treatment for a mental
5 health condition, specializes in behavioral health and has experience in
6 the delivery of mental health courses of treatment and, where applica-
7 ble, possesses a current and valid non-restricted license, certificate,
8 or registration or, where no provision for a license, certificate or
9 registration exists, is credentialed by the national accrediting body
10 appropriate to the profession; and
11 [(E)] (vii) where applicable to such health care professional's scope
12 of practice, is clinically supported by a physician who possesses a
13 current and valid non-restricted license to practice medicine.
14 [(c)] Nothing [herein] in this subdivision shall be construed to
15 change any statutorily-defined scope of practice.
16 § 2. Subsection (b) of section 4900 of the insurance law, as amended
17 by chapter 586 of the laws of 1998, item (ii) of subparagraph (B) of
18 paragraph 1 as amended by chapter 41 of the laws of 2014, subparagraph
19 (C) as amended and subparagraph (D) of paragraph 1 as added by section
20 36 of subpart A of part BB of chapter 57 of the laws of 2019, is amended
21 to read as follows:
22 (b) "Clinical peer reviewer" means:
23 (1) [for purposes of title one of this article:
24 (A) a physician who possesses a current and valid non-restricted
25 license to practice medicine; or
26 (B) a health care professional other than a licensed physician who:
27 (i) where applicable, possesses a current and valid non-restricted
28 license, certificate or registration or, where no provision for a
29 license, certificate or registration exists, is credentialed by the
30 national accrediting body appropriate to the profession; and
31 (ii) is in the same profession and same or similar specialty as the
32 health care provider who typically manages the medical condition or
33 disease or provides the health care service or treatment under review;
34 or
35 (C) for purposes of a determination involving substance use disorder
36 treatment:
37 (i) a physician who possesses a current and valid non-restricted
38 license to practice medicine and who specializes in behavioral health
39 and has experience in the delivery of substance use disorder courses of
40 treatment; or
41 (ii) a health care professional other than a licensed physician who
42 specializes in behavioral health and has experience in the delivery of
43 substance use disorder courses of treatment and, where applicable,
44 possesses a current and valid non-restricted license, certificate or
45 registration or, where no provision for a license, certificate or regis-
46 tration exists, is credentialed by the national accrediting body appro-
47 priate to the profession; or
48 (D) for purposes of a determination involving treatment for a mental
49 health condition:
50 (i) a physician who possesses a current and valid non-restricted
51 license to practice medicine and who specializes in behavioral health
52 and has experience in the delivery of mental health courses of treat-
53 ment; or
54 (ii) a health care professional other than a licensed physician who
55 specializes in behavioral health and has experience in the delivery of
56 mental health courses of treatment and, where applicable, possesses a
S. 8844 4
1 current and valid non-restricted license, certificate, or registration
2 or, where no provision for a license, certificate or registration
3 exists, is credentialed by the national accrediting body appropriate to
4 the profession; and
5 (2) for purposes of title two of this article:
6 (A)] a physician who:
7 [(i)] (A) possesses a current and valid non-restricted license to
8 practice medicine under article one hundred thirty-one of the education
9 law;
10 [(ii)] (B) where applicable, is board certified or board eligible in
11 the same or similar specialty as the health care provider who typically
12 manages the medical condition or disease or provides the health care
13 service or treatment under review or appeal;
14 [(iii)] (C) has been practicing in such area of specialty for a period
15 of at least five years; [and]
16 (D) for purposes of a determination involving substance use disorder
17 treatment, possesses a current and valid non-restricted license to prac-
18 tice medicine and who specializes in behavioral health and has experi-
19 ence in the delivery of substance use disorder courses of treatment;
20 (E) for purposes of a determination involving treatment for a mental
21 health condition, possesses a current and valid non-restricted license
22 to practice medicine and who specializes in behavioral health and has
23 experience in the delivery of mental health courses of treatment; and
24 [(iv)] (F) is knowledgeable about the health care service or treatment
25 under review or appeal; or
26 [(B)] (2) a health care professional other than a licensed physician
27 who possesses a current and valid non-restricted license or certif-
28 ication under title eight of the education law:
29 [(i)] (A) where applicable, possesses a current and valid non-res-
30 tricted license, certificate or registration;
31 [(ii)] (B) where applicable, is credentialed by the national accredit-
32 ing body appropriate to the profession in the same profession and same
33 or similar specialty as the health care provider who typically manages
34 the medical condition or disease or provides the health care service or
35 treatment under review or appeal;
36 [(iii)] (C) has been practicing in such area of specialty for a period
37 of at least five years;
38 [(iv)] (D) for purposes of a determination involving substance use
39 disorder treatment, specializes in behavioral health and has experience
40 in the delivery of substance use disorder courses of treatment and,
41 where applicable, possesses a current and valid non-restricted license,
42 certificate or registration or, where no provision for a license,
43 certificate or registration exists, is credentialed by the national
44 accrediting body appropriate to the profession;
45 (E) for purposes of a determination involving treatment for a mental
46 health condition, specializes in behavioral health and has experience in
47 the delivery of mental health courses of treatment and, where applica-
48 ble, possesses a current and valid non-restricted license, certificate,
49 or registration or, where no provision for a license, certificate or
50 registration exists, is credentialed by the national accrediting body
51 appropriate to the profession;
52 (F) is knowledgeable about the health care service or treatment under
53 review or appeal; and
54 [(v)] (G) where applicable to such health care professional's scope of
55 practice, is clinically supported by a physician who possesses a current
56 and valid non-restricted license to practice medicine.
S. 8844 5
1 [(3)] Nothing [herein] in this subdivision shall be construed to
2 change any statutorily-defined scope of practice.
3 § 3. This act shall take effect on the same date and in the same
4 manner as subpart A of part BB of chapter 57 of the laws of 2019, or on
5 the ninetieth day after it shall have become a law, whichever is later.