N.Y. Comp. Codes R. & Regs. tit. 11 § 152.8

Current through Register Vol. 46, No. 50, December 11, 2024

Section 152.8 - Standards for risk management programs conducted for qualification in the excess medical malpractice insurance program

In order to be eligible for participation in the Medical Malpractice Excess Insurance Program (or remain eligible if currently participating in that program), a physician must successfully complete an Excess Medical Malpractice Risk Management Program that meets the following requirements:

(a) The program must consist of at least two components:

(1) an excess medical malpractice risk management basic course; and

(2) an excess medical malpractice risk management follow-up course to be taken once every two years thereafter.

(b) The excess medical malpractice risk management basic course must:

(1) meet the requirements for Category 1 continuing medical education credit;

(2) be in either:

(i) a lecture (or other classroom setting) format, of at least five hours in length exclusive of any breaks, covering topics related to risk management, including but not limited to recordkeeping, informed consent, legislation, legal environment, communication with patients, office procedures, and critical review of case studies, at least two hours of which shall consist of subject matter that is dedicated to topics related to the higher potential exposure of the excess insurance risk; or

(ii) an internet-based format, requiring interaction by the insured physician, that is equivalent to the time and content of the lecture format described in subparagraph (i) of this paragraph;

(3) require the insured physician, subsequent to the lecture or internet-based course set forth in paragraph (2) of this subdivision, to complete a project (such as the critical review of case studies), which is designed to demonstrate and reinforce the concepts taught in the course and which must be returned to the insurer (or the entity conducting the risk management program) within 60 days after completion of the basic course lecture or internet-based course.

(c) Satisfactory completion of both the lecture or the internet-based course, and the project is required in order to participate in the Excess Medical Malpractice Insurance Program.

(d) In order to remain eligible for participation in the Excess Medical Malpractice Insurance Program in succeeding policy years, the physician must complete an annual excess medical malpractice follow-up course once every two years, which must:

(1)

(i) consist of a lecture (or other classroom setting) format of at least three hours in length exclusive of breaks. At least one hour of the course shall consist of subject matter that is dedicated to topics related to the higher potential exposure of the excess insurance product; or

(ii) consist of an internet-based course format, requiring interaction by the insured physician, that is equivalent to the time and content of the lecture format described in subparagraph (i) of this paragraph;

(2) be designed to reinforce the concepts covered in the excess medical malpractice basic risk management course and to bring to the insured's attention any relevant developments since completion of the basic course;

(3) unless provided in the excess medical malpractice risk management basic course, contain material specific to the insured's medical specialty; and

(4) require the insured physician, subsequent to the lecture or the internet-based component of the course, to complete a project (such as the critical review of case studies), which is designed to demonstrate and reinforce the concepts taught in the course and which must be returned to the insurer (or the entity conducting the risk management program) within 60 days after completion of each follow-up course.

(e) If the program is presented in the lecture format, it must contain a methodology for verifying that the insured physician is present for the entire lecture period for both the basic and follow-up courses, and that the required project is completed by the insured physician in a satisfactory manner. If the program is presented in an internet-based format, it must contain a methodology for verifying that the insured physician has logged on, taken and completed required basic or follow-up course and completed the required project in a satisfactory manner. In addition, the insurer or the entity conducting the internet-based program must require the insured physician to affirm that he or she was the person who actually took the program and that he or she is aware that any benefit granted pursuant to completion of the program is based on his or her affirmation.

(f) If the program is presented in the lecture format, it must be taught by persons with appropriate expertise in the subject areas being covered. If the program is presented in an internet- based format, the program must be developed by persons or entities with appropriate technological expertise, and the program content must be developed by persons or entities with appropriate expertise in the subject areas covered.

(g) The program must contain a provision whereby an insured who transfers excess medical malpractice insurance coverage from another insurer will continue to participate in the Excess Medical Malpractice Insurance Program, but only if the insured has completed all requirements for such participation.

(h)

(1) The program must be administered by the insurer or, after the insurer has investigated the entity's qualification, by an entity designated by the insurer to administer the program on its behalf.

(2)

(i) The superintendent, pursuant to section 42 of part A of chapter 1 of the Laws of 2002, as amended by section 16 of part J of chapter 82 of the Laws of 2002 and chapter 420 of the Laws of 2005, has designated the Medical Society of the State of New York (the Medical Society) to review those portions of the basic and follow-up courses dedicated to the excess risk of each insurer's program in order to assure that the subject matter addresses the excess exposure and is consistent among all insurers offering the Excess Medical Malpractice Insurance Program.

(ii) Subject to the approval by the superintendent, the Medical Society shall develop guidelines for use in evaluating the courses submitted to it for review. A copy of these guidelines shall be provided to an insurer upon request.

(iii) The Medical Society shall complete its review and provide a determination of any course submitted to it within 30 days of receiving all needed information. Failure to render a determination within such period is deemed a denial.

(iv) An insurer may, within 30 days, appeal an adverse determination by the Medical Society to the superintendent.

N.Y. Comp. Codes R. & Regs. Tit. 11 § 152.8