165.976 Substituting Nurse Practitioners For Licensed Primary Care Physicians: MSSNY will seek legislation prohibiting the substitution of licensed primary care physicians with nurse practitioners, and will continue its public opposition to replacing physicians with physician extenders. In recognition of a patient’s right to receive high quality medical care
165.975 Retroactive Denials: MSSNY working through the Committee on State Legislation will strongly support the introduction of appropriate legislation to require all health insurers in this State, including HMOs, to be precluded from retroactively denying reimbursement to physicians for patients’ admissions to hospitals. (HOD 1997-78; Reaffirmed HOD 2014;
165.974 “Hold Harmless” Protection for Physicians Under Contract: MSSNY will included in its policies and practices educating the physician on how such “Hold Harmless” clauses can serve to protect the physician or to increase risk exposure. (HOD 1997-79; Reaffirmed HOD 2014; Reaffirmed HOD 2024)
165.973 Patient Access to Physicians No Longer On Plan: MSSNY will seek legislation which would enable enrollees to a managed care plan to continue to receive care from the enrollee’s current physician for up to one year or the balance of their policy period, whichever is longer, where the
165.971 Retrospective Denial of Insurance Claims: MSSNY will seek legislation which would amend subdivision (4) of section 4903 of the public health law and subdivision (d) of section 4903 of the insurance law which require health maintenance organizations and insurers to “make a utilization review determination involving a health care
165.970 DEA Numbers Should Not Be Used As A Means Of Physician Identification: SUNSET HOD 2024
165.969 Managed Care Companies and The Practice Of Medicine Without A License: MSSNY will support legislation or regulation that will declare that any person making decisions on the medical necessity or appropriateness of care affecting the diagnosis or treatment of a patient in New York must have a license
165.968 Liability of Managed Care Entities As Well As Their Employees, Agents, Ostensible Agents And Representatives: MSSNY will develop or support legislation or regulation requiring that whenever an employee, agent, ostensible agent and/or representative of a managed care entity makes a determination that affects a patient’s health, both the individual and the entity should be
165.967 Managed Care Organizations to Standardize Pre-Certification: MSSNY will encourage managed care organizations to standardize pre-certification procedures and time limits for HMOs to respond to pre-certification requests for patient care regardless of the time of day or day of week. (HOD 1997-254; Reaffirmed HOD 2014; Reaffirmed HOD 2024)
165.966 Uniform Application Form, Uniform Encounter Form: MSSNY supports the establishment and use of a uniform application and a uniform encounter form to be used by all HMOs, IPOs, HPOs and IPAs. (HOD 97-273; Reaffirmed HOD 2014; Reaffirmed HOD 2024)
