Bill S6459-2013

Shortens time frames during which an insurer has to determine whether a pre-authorization request is medically necessary

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.

Details

Actions

  • Jan 27, 2014: REFERRED TO INSURANCE

Memo

BILL NUMBER:S6459

TITLE OF BILL: 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

PURPOSE: To shorten time frames during which an insurer has to determine whether a pre-authorization request is medically necessary.

SUMMARY OF PROVISIONS:

Section 1. Amends Subsection (b) of section 4903 of the insurance law to require that a utilization review agent shall make a determination involving health care services which require pre-authorization and provide notice of the determination to the insured by telephone and in writing within three days, rather than three business days, of receipt of the necessary information.

Section 2. Amends subdivision 2 of section 4903 of the public health law to require that a utilization review agent shall make a utilization review determination involving health care services which require preauthorization and provide notice of a determination to the enrollee by telephone and in writing within three days of receipt of the necessary information.

Section 3. Effective date.

JUSTIFICATION: Hospitalized patients must receive pre-authorization from their insurance companies in order to have some health care services covered, including the transfer of a patient from a hospital to a nursing home or rehabilitation center. Currently, the timeframe within which insurance companies must issue this determination is three business days. However, this time frame is too long for many patients, particularly over long holiday weekends. During holiday weekends, the patient must wait an additional three to four days in the hospital without beginning to recover.

The current time frame prevents many patients from leaving the hospital as they prepare to be transferred to a rehabilitation facility. These rehabilitation facilities are often prepared to accept the patient, but cannot do so without pre-authorization from the insurance company.

Many of these insurance companies already have customer service representatives available during these days to answer questions from individuals or to sign up individuals for coverage. This bill would shorten the time frame within which approval is required so that hospitalized patients can begin the healing process in a timely manner.

LEGISLATIVE HISTORY: New bill.

FISCAL IMPLICATIONS: None.

EFFECTIVE DATE: This act shall take effect on the same date and in the same manner as section 5 of chapter 514 of the laws of 2013, takes effect.


Text

STATE OF NEW YORK ________________________________________________________________________ 6459 IN SENATE January 27, 2014 ___________
Introduced by Sen. CARLUCCI -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance 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: Section 1. Subsection (b) of section 4903 of the insurance law, as amended by chapter 514 of the laws of 2013, is amended to read as follows: (b) A utilization review agent shall make a utilization review deter- mination involving health care services which require pre-authorization and provide notice of a determination to the insured or insured's desig- nee and the insured's health care provider by telephone and in writing within three [business] days of receipt of the necessary information. To the extent practicable, such written notification to the enrollee's health care provider shall be transmitted electronically, in a manner and in a form agreed upon by the parties. S 2. Subdivision 2 of section 4903 of the public health law, as amended by chapter 514 of the laws of 2013, is amended to read as follows: 2. A utilization review agent shall make a utilization review determi- nation involving health care services which require pre-authorization and provide notice of a determination to the enrollee or enrollee's designee and the enrollee's health care provider by telephone and in writing within three [business] days of receipt of the necessary infor- mation. To the extent practicable, such written notification to the enrollee's health care provider shall be transmitted electronically, in a manner and in a form agreed upon by the parties. S 3. This act shall take effect on the same date and in the same manner as section 5 of chapter 514 of the laws of 2013, takes effect.

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