NY A07120

Expands the definition of "health care plan" under the Financial Services Law to include provisions of health benefits under Section 162 of the Civil Service Law, allowing more health plans to access independent dispute resolution processes.

Removes the requirement that independent dispute resolution entities consider "the median of the rate recognized by the health care plan to reimburse similarly qualified providers for the same or similar services in the same region that are participating with the health care plan" when determining reasonable fees.

Retains existing criteria for determining reasonable fees including provider training and experience, usual charges, case complexity, patient characteristics, and customary costs for physician services.

Takes effect immediately upon enactment.