NY A03885

Expands the definition of "health care plan" to include health benefits provided under section 162 of the civil service law, bringing state employee health plans under the independent dispute resolution framework

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" when determining reasonable fees

Retains other criteria for fee determinations including provider training and experience, usual charges, case complexity, patient characteristics, and usual and customary cost of service

Applies to disputes between health care providers and insurers, HMOs, municipal cooperative health plans, and student health plans over out-of-network billing