S T A T E O F N E W Y O R K
________________________________________________________________________
8592
2009-2010 Regular Sessions
I N A S S E M B L Y
May 29, 2009
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Introduced by M. of A. LANCMAN -- read once and referred to the Commit-
tee on Insurance
AN ACT to amend the insurance law, in relation to requiring health
insurance companies to provide participating health care providers
with a list of health care treatments and services that require preau-
thorization from the health insurance company; and to amend the public
health law, in relation to pre-authorized services
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. 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 FROM SUCH HEALTH CARE INSURANCE COMPANY.
S 2. The public health 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 FROM SUCH
HEALTH CARE PLAN. 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 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 BY THE HEALTH CARE PLAN.
S 3. The insurance 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.
LBD04661-04-9
A. 8592 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 FROM SUCH
HEALTH CARE PLAN. 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 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 BY THE HEALTH CARE PLAN.
S 4. 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.