Bill Text: NY A05375 | 2025-2026 | General Assembly | Introduced

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Bill Title: Prohibits any insurer issuing a policy of hospital, medical, or surgical expense insurance or a medical assistance program from denying payment for anesthesia services solely because the duration of care exceeded a pre-set time limit.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced) 2025-02-13 - referred to insurance [A05375 Detail]

Download: New_York-2025-A05375-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          5375

                               2025-2026 Regular Sessions

                   IN ASSEMBLY

                                    February 13, 2025
                                       ___________

        Introduced by M. of A. WEPRIN -- read once and referred to the Committee
          on Insurance

        AN  ACT  to  amend  the  insurance  law  and the social services law, in
          relation to prohibiting health insurers, including medical  assistance
          programs, from imposing arbitrary time caps on reimbursement for anes-
          thesia services

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

     1    Section 1. The insurance law is amended by adding a new  section  3246
     2  to read as follows:
     3    § 3246. Prohibition on arbitrary time caps for anesthesia services. 1.
     4  An  insurer  issuing  a policy of hospital, medical, or surgical expense
     5  insurance pursuant to this section or any other section of law shall not
     6  impose arbitrary time caps  on  reimbursement  for  anesthesia  services
     7  provided during medically necessary procedures.
     8    2.  Reimbursement for anesthesia services shall be determined based on
     9  medical necessity as  assessed  by  the  attending  anesthesiologist  or
    10  licensed anesthesia provider.
    11    3.  An  insurer  issuing  a  policy  of hospital, medical, or surgical
    12  expense insurance pursuant to this section or any other section  of  law
    13  shall  be prohibited from denying payment for anesthesia services solely
    14  because the duration of care exceeded a pre-set time limit.
    15    4. The department of health shall:
    16    (a) conduct periodic audits of health insurers  to  access  compliance
    17  with the provisions of this section; and
    18    (b)  investigate  allegations  of noncompliance with the provisions of
    19  this section by patients, providers and other stakeholders.
    20    5. Not later than one year from the effective date  of  this  section,
    21  and  every three years thereafter, the department of health shall submit
    22  a report to the speaker of the assembly and the temporary  president  of
    23  the senate. Such report shall include:

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD09176-01-5
        A. 5375                             2

     1    (a)  the findings of any audits conducted pursuant to paragraph (a) of
     2  subdivision four of this section;
     3    (b)  the  number  and  nature  of violations of the provisions of this
     4  section reported; and
     5    (c)  recommendations,  if  any,  for  improving  compliance  with  the
     6  provisions of this section.
     7    §  2. The social services law is amended by adding a new section 365-q
     8  to read as follows:
     9    § 365-q. Prohibition on arbitrary time caps for  anesthesia  services.
    10  Any  medical  assistance  provider whose medical assistance includes the
    11  provision of anesthesia, including such assistance furnished  through  a
    12  managed  care  program,  shall  not be subject to arbitrary time caps on
    13  reimbursement when furnished during medically necessary  procedures,  as
    14  determined  by  the attending anesthesiologist or other provider of such
    15  anesthesia, and such payment shall not be  denied  for  such  assistance
    16  solely  because  the duration of such assistance exceeded a pre-set time
    17  limit.
    18    § 3. This act shall take effect immediately.