New York State Assembly

 
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A02880 Summary:

A02880 Actions:

A02880 Committee Votes:

Committee:INSURANCE   Chair:Cahill      
DATE:05/21/2019AYE/NAY:23/0  Action: Favorable refer to committee Codes        
Cahill
Aye
Garbarino
Aye
Cook
Aye
Hawley
Aye
Pretlow
Aye
Blankenbush
Aye
Rivera
Excused
Finch
Aye
Cymbrowitz
Aye
Raia
Aye
Lavine
Aye
Palmesano
Aye
Steck
Aye
Byrne
Aye
Dilan
Aye
Hunter
Aye
Simotas
Aye
Walker
Aye
Niou
Aye
Rosenthal
Aye
Stern
Aye
McDonald
Aye
Romeo
Aye
Jacobson
Aye

Committee:CODES   Chair:Lentol      
DATE:05/30/2019AYE/NAY:19/0  Action: Favorable         
Lentol
Aye
Ra
Aye
Schimminger
Aye
Giglio
Excused
Pretlow
Aye
Montesano
Excused
Cook
Aye
Morinello
Aye
Cymbrowitz
Aye
Palumbo
Aye
O'Donnell
Absent
Garbarino
Aye
Lavine
Aye
Perry
Aye
Zebrowski
Aye
Abinanti
Aye
Weprin
Aye
Mosley
Aye
Hevesi
Aye
Fahy
Aye
Seawright
Aye
Rosenthal
Aye

A02880 Floor Votes:

A02880 Text:

 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         2880--B
                                                                Cal. No. 493
 
                               2019-2020 Regular Sessions
 
                   IN ASSEMBLY
 
                                    January 28, 2019
                                       ___________
 
        Introduced by M. of A. HUNTER -- read once and referred to the Committee
          on  Insurance  --  reported  and referred to the Committee on Codes --
          advanced to a third reading, passed by Assembly and delivered  to  the
          Senate,  recalled  from  the  Senate, vote reconsidered, bill amended,
          ordered reprinted, retaining its place on the order of  third  reading
          --  again  amended  on third reading, ordered reprinted, retaining its
          place on the order of third reading
 
        AN ACT to amend the insurance law, in relation to denial of coverage  of
          additional  or  related  services or procedures related to health care
          services for which pre-authorization was granted or  did  not  require
          pre-authorization; and to repeal certain provisions of such law relat-
          ing thereto
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
 
     1    Section 1.  Subsection (c) of section 3238 of  the  insurance  law  is
     2  REPEALED and a new subsection (c) is added to read as follows:
     3    (c)(1)  If a health care provider, while providing a service or proce-
     4  dure to treat a patient, determines  that  providing  an  additional  or
     5  related  service or procedure, such as a service or procedure to address
     6  a co-morbid condition, is immediately necessary as part of  such  treat-
     7  ment,  and  in the clinical judgment of the health care provider it is a
     8  medically timely service and it would  not  be  medically  advisable  to
     9  interrupt  the  provision of care to the patient in order to obtain pre-
    10  authorization from a health plan for the additional or  related  service
    11  or  procedure, a denial of payment for the additional or related service
    12  or procedure due to lack of pre-authorization shall be upheld on  appeal
    13  only if it is determined that:
    14    (i)  the  additional  or related service or procedure is not a covered
    15  benefit;
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD04761-07-9
        A. 2880--B                          2
 
     1    (ii) the additional or related service or procedure was not  medically
     2  necessary  pursuant  to  section four thousand nine hundred four of this
     3  chapter or section forty-nine hundred four of the public health law;
     4    (iii)  the additional or related service or procedure was experimental
     5  or investigational pursuant to section four thousand nine  hundred  four
     6  of  this chapter or section forty-nine hundred four of the public health
     7  law; or
     8    (iv) one of the conditions set forth in paragraphs one through six  of
     9  subsection (a) of this section is met.
    10    (2)  The  provisions  of  this subsection shall apply to situations in
    11  which pre-authorization  was  required  and  received  for  the  initial
    12  service or procedure.
    13    (3)  The  provisions  of this subsection shall apply without regard to
    14  whether the current procedural terminology (CPT) code for the additional
    15  or related service or procedure is different than the CPT code  for  the
    16  initial service or procedure.
    17    §  2.  This  act shall take effect on the ninetieth day after it shall
    18  have become a law.