Bill Text: NY A05629 | 2021-2022 | 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 1-0)

Status: (Introduced - Dead) 2022-01-05 - referred to insurance [A05629 Detail]

Download: New_York-2021-A05629-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          5629

                               2021-2022 Regular Sessions

                   IN ASSEMBLY

                                    February 22, 2021
                                       ___________

        Introduced by M. of A. JOYNER -- read once and referred to the Committee
          on Insurance

        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.
                                                                   LBD03582-01-1
        A. 5629                             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. Effective immediately the superintendent of financial
    31  services  is  hereby  authorized to promulgate all rules and regulations
    32  and take any other measures necessary to  implement  this  act  on  such
    33  effective date.