165.995                   Organized Medical Staffs in Managed Care Entities

165.995                   Organized Medical Staffs in Managed Care Entities:

It is MSSNY policy that managed care entities establish self-governing medical staffs similar, if not identical, to those in hospitals. The principles of self-governance should include, but not be limited to:

• the development of medical Staff Bylaws which cannot be unilaterally changed by the governing of managed care entity;
• physician selection representatives to the governing board and other appropriate committees of managed care entities including credentialing, privileging, quality assurance and utilization review committees;
• due process protections for physicians credentialed by a managed care entity; and full indemnification by managed care entities of physicians who, in good faith, serve as members of credentialing, quality assurance and utilization review committees of managed care entities. (HOD 1994-102; Reaffirmed HOD 2014)