NY A06803

Authorizes health care providers in 11 New York counties (Albany, Columbia, Greene, Orange, Rensselaer, Saratoga, Schenectady, Schoharie, Ulster, Warren, and Washington) to collectively negotiate contract terms with health care plans as a 3-year demonstration program

Permits negotiation on non-fee matters including utilization review procedures, coverage provisions, medical necessity definitions, drug formularies, quality assurance programs, and provider selection criteria

Allows fee-related collective negotiation (reimbursement rates, capitation amounts, discounts) only when a health care plan holds substantial market share exceeding 10% of covered lives or 25,000 lives in the service area

Requires health care providers' representatives to register with and obtain approval from the Commissioner of Health before negotiations, with mandatory reporting every 30 days on negotiation progress

Establishes a mediation and fact-finding process when negotiations reach impasse, with the Commissioner authorized to order a resolution if parties cannot reach agreement within 20 days of receiving recommendations