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§4325
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§4325 . Prohibitions.
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§4325(a)
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(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:
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§4325(a)(1)
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(1) a condition or a course of treatment with a subscriber including the availability of other therapies, consultations, or tests; or
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§4325(a)(2)
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(2) the provisions, terms, or requirements of the corporation's products as they relate to the subscriber.
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§4325(b)
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(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.
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§4325(c)
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(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.
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§4325(d)
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(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.
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§4325(e)
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(e) Contracts entered into between an insurer and a health care provider shall include terms which prescribe:
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§4325(e)(1)
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(1) the method by which payments to a provider, including any prospective or retrospective adjustments thereto, shall be calculated;
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§4325(e)(2)
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(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;
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§4325(e)(3)
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(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;
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§4325(e)(4)
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(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
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§4325(e)(5)
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(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 75 of the civil practice law and rules.
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§4325(f)
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(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 subdivision 1 of §4403 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.
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§4325(g)
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(g) Any contract provision, written policy or written procedure in violation of (this §) shall be deemed to be void and unenforceable.
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§4325(h)
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* (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 2 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 15 days after commencement of the 2- month period. The commissi1r health shall have the authority to waive the 2- month period upon the request either party to a contract that is being terminated for cause. (this sub§) shall not apply where both parties mutually agree in writing to the termination or non-renewal the corporation provides notice to the subscriber at least 30 days in advance of the date of contract termination.
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* NB Repealed June 30, 2009 Source Data downloaded: 2009-04-09 15: 12: 49; Processed: 2009-05-08 15: 36: 10
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