N.Y. Comp. Codes R. & Regs. tit. 10 § 91.2

Current through Register Vol. 46, No. 51, December 18, 2024

Section 91.2 - Reporting requirements

(a) Physicians and dentists who have professional privileges in a general hospital providing emergency medical care and who, from time to time, provide emergency medical care in such hospital, and who wish to avail themselves of the excess malpractice insurance coverage or equivalent excess coverage, shall submit a request in writing to the hospital with which the physician or dentist is primarily affiliated, as determined pursuant to this section, by October 24, 1986 for the period July 1, 1986 through June 30, 1987 and in accordance with notices issued by the pool administrator for annual periods beginning July 1st, thereafter, for certification of eligibility for purchase of excess malpractice insurance coverage or equivalent excess coverage as defined in section 91.1 of this Part. This request shall contain appropriate documentation and assurances that the required primary insurance is in force and will be maintained. This request shall set forth the number of admissions for each hospital where the physician or dentist has admitting privileges and the number of consultative visits for each hospital where he/she provides such services. If the physician or dentist has professional privileges in more than one general hospital, then the physician or dentist shall designate and submit the request for certification to the general hospital with which he/she is primarily affiliated. Primary affiliation shall be determined based on such factors as the number of hospital admissions or consultative services in the designated hospital in the immediate preceding fiscal year compared with hospital admissions and/or services for such period in other general hospitals in which the physician or dentist, from time to time, provides emergency medical or dental care to persons who require such care.

(b)

(1) A physician or dentist should designate as his/her primary affiliation that facility where the practitioner has the majority of admissions and/or consultative services.

(2) A physician or dentist may, however, provide an alternative designation. If another facility is so designated, the physician or dentist shall provide a justification in the written request for certification of eligibility as to the reason for the alternative designation.

(c)

(1) A hospital shall accept the designation or alternative designation of primary affiliation by a physician or dentist requesting such designation in accordance with paragraphs (b)(1) and (2) of this section, unless it has knowledge and information requiring it to reject the designation or alternative designation.

(2) If the hospital rejects a designation or an alternative designation, then it must provide written justification and specific reasons for denying the request to the physician or dentist based upon the criteria set forth in subdivision (a) of this section, and considering any justification for an alternative designation provided by the physician or dentist in accordance with paragraph (b)(2) of this section within five business days of receipt of the written request. If the hospital does not reject within five business days, the request for designation shall be deemed acceptable.

(d) All general hospitals providing emergency medical care shall certify in writing by November 7, 1986, for the periods July 1, 1986 through June 30, 1987 and in accordance with notices issued by the pool administrator for annual periods beginning July 1st, thereafter, on forms acceptable to the Superintendent of Insurance and the Commissioner of Health, those physicians and dentists who are eligible for excess medical malpractice coverage and the number of admissions and/or consultative visits for each hospital where such services are provided.

(e)

(1) If a dispute arises, the hospital and physician or dentist shall have until the general hospital certification deadline established in subdivision (d) of this section in which they may resolve any differences regarding primary affiliation and provide the certification of eligibility to the Superintendent of Insurance and the Commissioner of Health.

(2) If a physician or dentist is not certified eligible based upon such differences, the physician or dentist may designate in accordance with subdivision (b) of this section and request certification of eligibility by another general hospital as his/her primary affiliation within seven days of the deadline established in subdivision (d) of this section. Such designation must be actually received by the alternate designated hospital within such seven-day period. Within seven days of the receipt of the designation and request for certification of eligibility, such general hospital shall submit a certification of eligibility to the Superintendent of Insurance and Commissioner of Health or reject such designation.

(f) Physicians and dentists eligible or applying for certification of eligibility for purchase of excess malpractice insurance coverage shall complete and submit such applications and forms approved by the Superintendent of Insurance as required by the excess liability insurance carrier(s) for purchase of the excess liability insurance.

(g) All hospitals shall be required, on a form acceptable to the Superintendent of Insurance and the Commissioner of Health, to notify in writing every physician or dentist receiving new admitting privileges, who has not been certified eligible for excess malpractice insurance coverage pursuant to this Part at another general hospital, of the availability of excess malpractice insurance coverage under the criteria set forth in subdivision (a) of this section. Such physician or dentist may designate such general hospital and request certification of eligibility for purchase of excess malpractice insurance coverage in accordance with this section. Such physician or dentist certified eligible in accordance with this section may receive the excess malpractice insurance coverage prospectively from the date the requirements of the excess liability insurance carrier(s) are satisfied.

(h) Any physician or dentist who has not requested or received certification of eligibility for purchase with excess malpractice insurance coverage or who did not satisfy the requirements of the excess liability insurance carrier in accordance with subdivision (f) of this section may apply for designation, certification and purchase of such excess malpractice insurance coverage in accordance with this Part and may receive excess malpractice insurance coverage prospectively from the date the requirements of the excess liability insurance carrier are satisfied.

N.Y. Comp. Codes R. & Regs. Tit. 10 § 91.2