NY A05692

Allows health care providers to collectively negotiate non-fee related terms with health care plans, including utilization review procedures, coverage provisions, medical necessity definitions, clinical practice guidelines, drug formularies, payment procedures, and quality assurance programs.

Permits collective negotiation over fees and reimbursement rates only if the health care plan has substantial market share (exceeding 10% of covered lives or 25,000 lives in the geographic area) that significantly exceeds the individual market share of the providers.

Requires health care providers' representatives to file with the Commissioner for approval before negotiating, submit reports identifying proposed negotiation subjects and expected benefits, and receive Commissioner approval of any resulting agreements within 60 days.

Establishes a dispute resolution process including mediation and fact-finding boards, with the Commissioner authorized to order resolution based on fact-finding recommendations if an impasse continues for 20 days.

Prohibits strikes by health care providers, limits representatives to negotiating for no more than 30% of a provider market in the geographic area, and sets fees for representatives to cover departmental administrative costs.