Add §§4242 & 4905-a, Ins L; add §4905-a, Pub Health L
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.
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.
