S.3472/A.7214 – Physician Profile Information Mandate

This legislation, S.3472/A.7214, would require health care plan participation by physicians to be reported, for purposes of physician profiles, by the health care plans. The New York Health Plan Association (HPA) and its member health plans agree on the importance of consumers having information about the providers in their health plan’s network. However, putting the onus of providing this information to the New York Provider Profile on health plans instead of the provider themselves is misplaced. Accordingly, HPA opposes this legislation.

New York State’s Physician Profile is a state-maintained website that provides a wealth of information on providers practicing in New York that is valuable to consumers. Information that providers are required to report to the Physician Profile site include the provider’s education, languages they may speak and any legal actions that may have been taken against the provider. Additional information, including office locations and phone numbers, articles they may have written and list of health plans in which the doctor participates, is optional.

New York law also requires health plans to provide consumers with information on providers in their networks through the health plan’s provider directory. Information that plans’ directories are required to provide include: a listing of providers by specialty (if applicable), address(es) and telephone number(s) of all participating providers, as well as whether a provider is accepting new patients. For physicians, the directories must also include board certification, languages spoken, and any affiliations with participating hospitals.

The federal No Surprises Act (NSA), designed to protect consumers against surprise bills from providers, included provisions requiring providers to provide timely directory information to a health plan. This requirement was aimed at helping to ensure accuracy of health plan directories, thereby ensuring consumers would have up to date information when a provider leaves a plan network. While the NSA, also requires plans to verify and update the provider directory information on its website for each provider at least once every 90 days, and to make updates if a provider’s information changes, the federal law placed the onus on providers to communicate this information to plans. Quite simply, plans cannot produce information they do not have.

Currently are no enforcement mechanisms to compel providers to produce information. Although health plans are committed to providing their member with information they need to assist them in their choice of providers, when it comes to the actual provider information — whether in plan directories or the state’s Physician Profile — the focus needs to be on requiring providers, not health plans, to provide these updates.

For these reasons, we OPPOSE S.3472/A.7214.