Bill Text: NY S06790 | 2019-2020 | General Assembly | Introduced

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Bill Title: Enacts the "health insurance preauthorization disclosure act"; requires health insurance companies to provide participating health care providers with a list of health care treatments and services that require preauthorization from the health insurance company.

Spectrum: Partisan Bill (Democrat 7-0)

Status: (Introduced - Dead) 2020-01-08 - REFERRED TO INSURANCE [S06790 Detail]

Download: New_York-2019-S06790-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          6790

                               2019-2020 Regular Sessions

                    IN SENATE

                                    October 23, 2019
                                       ___________

        Introduced  by  Sen.  BAILEY -- read twice and ordered printed, and when
          printed to be committed to the Committee on Rules

        AN ACT to amend the insurance law and the public health law, in relation
          to enacting the "health insurance preauthorization disclosure act"

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

     1    Section  1.  Short  title. This act shall be known and may be cited as
     2  the "health insurance preauthorization disclosure act".
     3    § 2. The insurance law is amended by adding a new section 4242 to read
     4  as follows:
     5    § 4242. Health insurance companies; preauthorization for  health  care
     6  services.  Every  health  care  insurance  company  shall be required to
     7  provide participating physicians and health care providers,  as  defined
     8  in subdivision seven of section twenty-nine hundred eighty of the public
     9  health law, with an updated  list of health care treatments and services
    10  that  require preauthorization or precertification from such health care
    11  insurance company.  Such list shall be developed based upon consultation
    12  with medical guidelines developed  by  the  relevant  medical  specialty
    13  organization  and  in consultation with appropriately trained physicians
    14  practicing within the region the health care insurance  company  serves.
    15  Such  list  shall be updated annually or more frequently as appropriate.
    16  Only those health care services which are contained on such  list  shall
    17  be  subject  to pre-authorization or precertification by the health care
    18  insurance company. No health care treatment or service shall be added to
    19  the list of services  requiring  pre-authorization  or  precertification
    20  unless  the  health  care insurance company provides a minimum of ninety
    21  days notice to participating physicians and health care providers.
    22    § 3. The public health law is amended by adding a new  section  4905-a
    23  to read as follows:
    24    §  4905-a.  Pre-authorized  services.  Every health care plan shall be
    25  required to develop and provide to participating health care providers a

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD00098-01-9
        S. 6790                             2

     1  list of health care services that require pre-authorization  or  precer-
     2  tification  from  such  health  care  plan. Such list shall be developed
     3  based upon consultation with medical guidelines developed by  the  rele-
     4  vant  medical  specialty organization and in consultation with appropri-
     5  ately trained physicians practicing within the region  the  health  care
     6  plan  serves.  Such list shall be updated annually or more frequently as
     7  appropriate. Only those health care services which are contained on such
     8  list shall be subject to pre-authorization or  precertification  by  the
     9  health  care plan.  No health care service shall be added to the list of
    10  services requiring  pre-authorization  or  precertification  unless  the
    11  health care plan provides a minimum of ninety days notice to participat-
    12  ing health care providers.
    13    §  4.  The  insurance law is amended by adding a new section 4905-a to
    14  read as follows:
    15    § 4905-a. Pre-authorized services. Every health  care  plan  shall  be
    16  required to develop and provide to participating health care providers a
    17  list  of  health care services that require pre-authorization or precer-
    18  tification from such health care plan.  Such  list  shall  be  developed
    19  based  upon  consultation with medical guidelines developed by the rele-
    20  vant medical specialty organization and in consultation  with  appropri-
    21  ately  trained  physicians  practicing within the region the health care
    22  plan serves. Such list shall be updated annually or more  frequently  as
    23  appropriate. Only those health care services which are contained on such
    24  list  shall  be  subject to pre-authorization or precertification by the
    25  health care plan.  No health care service shall be added to the list  of
    26  services  requiring  pre-authorization  or  precertification  unless the
    27  health care plan provides a minimum of ninety days notice to participat-
    28  ing health care providers.
    29    § 5. This act shall take effect on the sixtieth  day  after  it  shall
    30  have  become  a law; provided, however that the superintendent of finan-
    31  cial services is hereby authorized to promulgate  all  rules  and  regu-
    32  lations  and  take any other measures necessary to implement this act on
    33  its effective date.