Bill Text: NY A05069 | 2023-2024 | General Assembly | Introduced

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Bill Title: Requires the use of the current edition of American medical association's current procedural terminology (CPT) with respect to claims for evaluation and management codes.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced) 2024-01-03 - referred to insurance [A05069 Detail]

Download: New_York-2023-A05069-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          5069

                               2023-2024 Regular Sessions

                   IN ASSEMBLY

                                      March 2, 2023
                                       ___________

        Introduced  by M. of A. GUNTHER -- read once and referred to the Commit-
          tee on Insurance

        AN ACT to amend the insurance law and the public health law, in relation
          to the processing of health claims

          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:

     1    Section  1.  Paragraph  2  of  subsection (a) of section 3224-b of the
     2  insurance law, as added by chapter 551 of the laws of 2006,  is  amended
     3  to read as follows:
     4    (2) Subject to the provisions of paragraph three of this subsection, a
     5  health  plan shall accept and initiate the processing of all health care
     6  claims submitted by a physician, including but not limited to evaluation
     7  and management codes,  pursuant  to  and  consistent  with  the  current
     8  version  of the American medical association's current procedural termi-
     9  nology (CPT) codes, reporting guidelines and conventions and the centers
    10  for medicare and medicaid services healthcare  common  procedure  coding
    11  system (HCPCS).
    12    §  2.  Paragraphs  4  and 5 of subsection (b) of section 3224-b of the
    13  insurance law, as amended by chapter 237 of the laws of 2009, are renum-
    14  bered paragraphs 5 and 6 and a new paragraph  4  is  added  to  read  as
    15  follows:
    16    (4)  Notwithstanding  paragraph three of this subsection, with respect
    17  to claims for evaluation and management codes as such  are  defined  and
    18  set  forth  in  the  current  edition  of American medical association's
    19  current procedural terminology (CPT), a health plan shall follow, comply
    20  with and implement for purposes of claims processing, claims payment and
    21  claims review, such current procedural  terminology  provisions,  guide-
    22  lines  and  conventions  for both the selection and the documentation of
    23  evaluation and management services.
    24    § 3. Section 4406-c of the public health law is amended by adding  two
    25  new subdivisions 13 and 14 to read as follows:

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD09869-01-3
        A. 5069                             2

     1    13.  A  health  maintenance  organization licensed pursuant to article
     2  forty-three of the insurance law or certified pursuant to  this  article
     3  or  an independent practice association certified or recognized pursuant
     4  to this article or a medical group shall not  prohibit  the  acceptance,
     5  initiation  and  processing  of  all  health  care claims submitted by a
     6  physician, including but not limited to evaluation and management codes,
     7  pursuant to and consistent with the  current  version  of  the  American
     8  medical  association's  current  procedural terminology (CPT), reporting
     9  guidelines and conventions and the centers  for  medicare  and  medicaid
    10  services healthcare common procedure coding system (HCPCS).
    11    14.  Notwithstanding  provisions  of this section or subsection (b) of
    12  section three thousand two hundred twenty-four  of  the  insurance  law,
    13  with  respect  to claims for evaluation and management codes as such are
    14  defined and set forth in the current edition of American medical associ-
    15  ation's current  procedural  terminology  (CPT),  a  health  plan  shall
    16  follow,  comply  with  and  implement for purposes of claims processing,
    17  claims payment and claims review, such  current  procedural  terminology
    18  provisions,  guidelines,  and  conventions for both the selection of and
    19  the documentation of evaluation and management services.
    20    § 4. The commissioner of health and the superintendent of the  depart-
    21  ment  of  financial  services shall promulgate rules and regulations and
    22  take any other actions reasonably necessary to implement the  provisions
    23  of this act.
    24    § 5. This act shall take effect immediately.