Bill Text: NY A05129 | 2015-2016 | General Assembly | Amended

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Bill Title: Shortens time frames during which an insurer has to determine whether a pre-authorization request is medically necessary from three business days to three days.

Spectrum: Moderate Partisan Bill (Democrat 23-4)

Status: (Introduced - Dead) 2016-02-02 - print number 5129a [A05129 Detail]

Download: New_York-2015-A05129-Amended.html

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                STATE OF NEW YORK
        ________________________________________________________________________
                                         5129--A
                               2015-2016 Regular Sessions
                   IN ASSEMBLY
                                    February 12, 2015
                                       ___________
        Introduced  by  M.  of  A. BRAUNSTEIN, WEPRIN, GOTTFRIED, OTIS, BRONSON,
          SKOUFIS,  GALEF,  GUNTHER,  CRESPO,  O'DONNELL,  GOODELL,   MONTESANO,
          ZEBROWSKI,  McDONOUGH,  HOOPER, STECK, ABINANTI, FRIEND -- Multi-Spon-
          sored by -- M. of  A.  COOK,  KEARNS,  PEOPLES-STOKES,  PERRY,  RAMOS,
          RIVERA,  SCHIMEL,  SEPULVEDA,  SIMANOWITZ -- read once and referred to
          the Committee on Insurance -- recommitted to the Committee  on  Insur-
          ance  in  accordance  with  Assembly  Rule  3,  sec.  2  --  committee
          discharged, bill amended, ordered reprinted as amended and recommitted
          to said committee
        AN ACT to amend the insurance law and the public health law, in relation
          to shortening time frames during which an  insurer  has  to  determine
          whether a pre-authorization request is medically necessary
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
     1    Section 1. Subsection (b) of section 4903 of  the  insurance  law,  as
     2  amended  by  section  12 of part H of chapter 60 of the laws of 2014, is
     3  amended to read as follows:
     4    (b) A utilization review agent shall make a utilization review  deter-
     5  mination  involving health care services which require pre-authorization
     6  and provide notice of a determination to the insured or insured's desig-
     7  nee and the insured's health care provider by telephone and  in  writing
     8  within three [business] days of receipt of the necessary information. To
     9  the  extent  practicable,  such  written  notification to the enrollee's
    10  health care provider shall be transmitted electronically,  in  a  manner
    11  and  in a form agreed upon by the parties.  The notification shall iden-
    12  tify: (1) whether the services are considered in-network or  out-of-net-
    13  work; (2) whether the insured will be held harmless for the services and
    14  not  be  responsible  for any payment, other than any applicable co-pay-
    15  ment, co-insurance or deductible; (3) as applicable, the  dollar  amount
    16  the  health care plan will pay if the service is out-of-network; and (4)
    17  as applicable, information explaining how an insured may  determine  the
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD03427-04-6