A199A-2011 Actions

• Jan 4, 2012: referred to insurance
• Mar 10, 2011: print number 199a
• Mar 10, 2011: amend and recommit to insurance
• Jan 5, 2011: referred to insurance

A199A-2011 Text

 S T A T E   O F   N E W   Y O R K
 
 199--A
 2011-2012 Regular Sessions
 I N  ASSEMBLY
 (PREFILED)
 January 5, 2011
 
 Introduced  by M. of A. LANCMAN -- read once and referred to the Commit
 tee on  Insurance  --  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 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:

 

Section 1. Short title. This act shall be known and may  be  cited  as
 the "health insurance preauthorization disclosure act".
 

S 2. The insurance law is amended by adding a new section 4242 to read
 as follows:

 

S  4242.  HEALTH INSURANCE COMPANIES; PREAUTHORIZATION FOR HEALTH CARE
 SERVICES. EVERY HEALTH CARE  INSURANCE  COMPANY  SHALL  BE  REQUIRED  TO
 PROVIDE  PARTICIPATING  PHYSICIANS AND HEALTH CARE PROVIDERS, AS DEFINED
 IN SUBDIVISION SEVEN OF SECTION TWENTY-NINE HUNDRED EIGHTY OF THE PUBLIC
 HEALTH LAW, WITH AN UPDATED  LIST OF HEALTH CARE TREATMENTS AND SERVICES
 THAT REQUIRE PREAUTHORIZATION OR PRECERTIFICATION FROM SUCH HEALTH  CARE
 INSURANCE COMPANY.  SUCH LIST SHALL BE DEVELOPED BASED UPON CONSULTATION
 WITH  MEDICAL  GUIDELINES  DEVELOPED  BY  THE RELEVANT MEDICAL SPECIALTY
 ORGANIZATION AND IN CONSULTATION WITH APPROPRIATELY  TRAINED  PHYSICIANS
 PRACTICING  WITHIN  THE REGION THE HEALTH CARE INSURANCE COMPANY SERVES.
 SUCH LIST SHALL BE UPDATED ANNUALLY OR MORE FREQUENTLY  AS  APPROPRIATE.
 ONLY  THOSE  HEALTH CARE SERVICES WHICH ARE CONTAINED ON SUCH LIST SHALL
 BE SUBJECT TO PRE-AUTHORIZATION OR PRECERTIFICATION BY THE  HEALTH  CARE
 INSURANCE COMPANY. NO HEALTH CARE TREATMENT OR SERVICE SHALL BE ADDED TO
 THE  LIST  OF  SERVICES  REQUIRED  PRE-AUTHORIZATION OR PRECERTIFICATION
 UNLESS THE HEALTH CARE INSURANCE COMPANY PROVIDES A  MINIMUM  OF  NINETY
 DAYS NOTICE TO PARTICIPATING PHYSICIANS AND HEALTH CARE PROVIDERS.
 

S  3.  The public health law is amended by adding a new section 4905-a
 to read as follows:

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD01359-03-1
 
       A. 199--A                           2
 

S 4905-A. PRE-AUTHORIZED SERVICES. EVERY HEALTH  CARE  PLAN  SHALL  BE
 REQUIRED TO DEVELOP AND PROVIDE TO PARTICIPATING HEALTH CARE PROVIDERS A
 LIST  OF  HEALTH CARE SERVICES THAT REQUIRE PRE-AUTHORIZATION OR PRECER
 TIFICATION FROM SUCH HEALTH CARE PLAN.  SUCH  LIST  SHALL  BE  DEVELOPED
 BASED  UPON  CONSULTATION WITH MEDICAL GUIDELINES DEVELOPED BY THE RELE
 VANT MEDICAL SPECIALTY ORGANIZATION AND IN CONSULTATION  WITH  APPROPRI
 ATELY  TRAINED  PHYSICIANS  PRACTICING WITHIN THE REGION THE HEALTH CARE
 PLAN SERVES. SUCH LIST SHALL BE UPDATED ANNUALLY OR MORE  FREQUENTLY  AS
 APPROPRIATE. ONLY THOSE HEALTH CARE SERVICES WHICH ARE CONTAINED ON SUCH
 LIST  SHALL  BE  SUBJECT TO PRE-AUTHORIZATION OR PRECERTIFICATION BY THE
 HEALTH CARE PLAN.  NO HEALTH CARE SERVICE SHALL BE ADDED TO THE LIST  OF
 SERVICES  REQUIRING  PRE-AUTHORIZATION  OR  PRECERTIFICATION  UNLESS THE
 HEALTH CARE PLAN PROVIDES A MINIMUM OF NINETY DAYS NOTICE TO PARTICIPAT
 ING HEALTH CARE PROVIDERS.
 

S 4. The insurance law is amended by adding a new  section  4905-a  to
 read as follows:

 

S  4905-A.  PRE-AUTHORIZED  SERVICES.  EVERY HEALTH CARE PLAN SHALL BE
 REQUIRED TO DEVELOP AND PROVIDE TO PARTICIPATING HEALTH CARE PROVIDERS A
 LIST OF HEALTH CARE SERVICES THAT REQUIRE PRE-AUTHORIZATION  OR  PRECER
 TIFICATION  FROM  SUCH  HEALTH  CARE  PLAN. SUCH LIST SHALL BE DEVELOPED
 BASED UPON CONSULTATION WITH MEDICAL GUIDELINES DEVELOPED BY  THE  RELE
 VANT  MEDICAL  SPECIALTY ORGANIZATION AND IN CONSULTATION WITH APPROPRI
 ATELY TRAINED PHYSICIANS PRACTICING WITHIN THE REGION  THE  HEALTH  CARE
 PLAN  SERVES.  SUCH LIST SHALL BE UPDATED ANNUALLY OR MORE FREQUENTLY AS
 APPROPRIATE. ONLY THOSE HEALTH CARE SERVICES WHICH ARE CONTAINED ON SUCH
 LIST SHALL BE SUBJECT TO PRE-AUTHORIZATION OR  PRECERTIFICATION  BY  THE
 HEALTH  CARE PLAN.  NO HEALTH CARE SERVICE SHALL BE ADDED TO THE LIST OF
 SERVICES REQUIRING  PRE-AUTHORIZATION  OR  PRECERTIFICATION  UNLESS  THE
 HEALTH CARE PLAN PROVIDES A MINIMUM OF NINETY DAYS NOTICE TO PARTICIPAT
 ING HEALTH CARE PROVIDERS.
 

S  5.  This  act  shall take effect on the sixtieth day after it shall
 have become a law; provided, however that the superintendent  of  insur
 ance  is  hereby  authorized to promulgate all rules and regulations and
 take any other measures necessary to implement this act on its effective
 date.

*By contributing or voting you agree to the Terms of Participation and Privacy Policy and verify you are over 13.

Discuss!