senate Bill S7071B

Signed By Governor
2011-2012 Legislative Session

Relates to denial of health insurance claims

download bill text pdf

Sponsored By

Archive: Last Bill Status Via A9946 -


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed by Governor

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Actions

view actions (15)
Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Aug 01, 2012 signed chap.297
Jul 20, 2012 delivered to governor
Jun 21, 2012 returned to assembly
passed senate
3rd reading cal.1474
substituted for s7071b
Jun 21, 2012 substituted by a9946b
ordered to third reading cal.1474
committee discharged and committed to rules
Jun 18, 2012 print number 7071b
amend (t) and recommit to finance
Jun 13, 2012 print number 7071a
amend (t) and recommit to finance
May 22, 2012 reported and committed to finance
Apr 27, 2012 referred to health

Votes

view votes

Jun 21, 2012 - Rules committee Vote

S7071B
24
0
committee
24
Aye
0
Nay
1
Aye with Reservations
0
Absent
0
Excused
0
Abstained
show Rules committee vote details

May 22, 2012 - Health committee Vote

S7071
12
0
committee
12
Aye
0
Nay
4
Aye with Reservations
0
Absent
1
Excused
0
Abstained
show committee vote details

Committee Vote: May 22, 2012

aye wr (4)
excused (1)

Co-Sponsors

S7071 - Details

See Assembly Version of this Bill:
A9946B
Law Section:
Insurance Law
Laws Affected:
Amd §§3217-b, 4325 & 3224-a, Ins L; amd §4406-c, Pub Health L
Versions Introduced in 2011-2012 Legislative Session:
A9946B, S7071, S7071A

S7071 - Summary

Relates to denial of health insurance claims.

S7071 - Sponsor Memo

S7071 - Bill Text download pdf

                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  7071

                            I N  S E N A T E

                             April 27, 2012
                               ___________

Introduced  by  Sen.  HANNON -- read twice and ordered printed, and when
  printed to be committed to the Committee on Health

AN ACT to amend the public health law and the insurance law, in relation
  to utilization review and denial of claims

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1. Subdivision 7 of section 4903 of the public health law, as
added by chapter 586 of the laws of 1998, is amended to read as follows:
  7. Failure by the utilization review agent  to  make  a  determination
within the time periods prescribed in this section shall be deemed to be
an  [adverse  determination  subject to appeal pursuant to section forty
nine hundred four of this title] APPROVAL.
  S 2. Subsection (g) of section 4903 of the insurance law, as added  by
chapter 586 of the laws of 1998, is amended to read as follows:
  (g)  Failure  by  the utilization review agent to make a determination
within the time periods prescribed in this section shall be deemed to be
an [adverse determination subject to appeal  pursuant  to  section  four
thousand nine hundred four of this title] APPROVAL.
  S  3.  Section  3224-a of the insurance law is amended by adding a new
subsection (i) to read as follows:
  (I)(1) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF SUBSECTION (B) OF
THIS SECTION, AN INSURER OR  ORGANIZATION  OR  CORPORATION  LICENSED  OR
CERTIFIED PURSUANT TO ARTICLE FORTY-THREE OR ARTICLE FORTY-SEVEN OF THIS
CHAPTER  OR  ARTICLE  FORTY-FOUR OF THE PUBLIC HEALTH LAW SHALL NOT DENY
PAYMENT FOR A CLAIM SUBMITTED BY A GENERAL HOSPITAL  CERTIFIED  PURSUANT
TO  ARTICLE  TWENTY-EIGHT  OF  THE  PUBLIC HEALTH LAW ON THE BASIS OF AN
ADMINISTRATIVE OR  TECHNICAL  DEFECT,  PROVIDED  THAT  AT  LEAST  NINETY
PERCENT  OF  THE  CLAIMS  OTHERWISE SUBMITTED BY THE GENERAL HOSPITAL TO
THAT INSURER OR ORGANIZATION OR CORPORATION  IN  THE  PREVIOUS  CALENDAR
YEAR  HAD  NO  ADMINISTRATIVE  OR TECHNICAL DEFECT. FOR PURPOSES OF THIS
SECTION, ADMINISTRATIVE OR TECHNICAL  DEFECT  MEANS  FAILURE  TO  FOLLOW
CONTRACTED  PROCEDURES IN ACCESSING SERVICES, INCLUDING, BUT NOT LIMITED
TO, FAILURE TO REQUEST APPROPRIATE  OR  NECESSARY  AUTHORIZATION  OF  AN
ADMISSION OR PROVISION OF SERVICES AND FAILURE TO PROVIDE PROPER NOTIFI-

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.

Co-Sponsors

S7071A - Details

See Assembly Version of this Bill:
A9946B
Law Section:
Insurance Law
Laws Affected:
Amd §§3217-b, 4325 & 3224-a, Ins L; amd §4406-c, Pub Health L
Versions Introduced in 2011-2012 Legislative Session:
A9946B, S7071, S7071A

S7071A - Summary

Relates to denial of health insurance claims.

S7071A - Sponsor Memo

S7071A - Bill Text download pdf

                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 7071--A

                            I N  S E N A T E

                             April 27, 2012
                               ___________

Introduced  by  Sens.  HANNON, LARKIN -- read twice and ordered printed,
  and when printed to  be  committed  to  the  Committee  on  Health  --
  reported  favorably from said committee and committed to the Committee
  on Finance -- committee discharged, bill amended, ordered reprinted as
  amended and recommitted to said committee

AN ACT to amend the insurance law, in relation to denial of claims

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1.  Section 3224-a of the insurance law is amended by adding a
new subsection (i) to read as follows:
  (I)(1) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF SUBSECTION (B) OF
THIS  SECTION,  AN  INSURER  OR  ORGANIZATION OR CORPORATION LICENSED OR
CERTIFIED PURSUANT TO ARTICLE FORTY-THREE OR ARTICLE FORTY-SEVEN OF THIS
CHAPTER OR ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW  SHALL  NOT  DENY
PAYMENT  FOR  A  CLAIM  FOR  A MEDICALLY NECESSARY SERVICE PROVIDED BY A
GENERAL HOSPITAL CERTIFIED  PURSUANT  TO  ARTICLE  TWENTY-EIGHT  OF  THE
PUBLIC HEALTH LAW ON THE BASIS OF AN ADMINISTRATIVE OR TECHNICAL DEFECT.
FOR  PURPOSES  OF THIS SECTION, ADMINISTRATIVE OR TECHNICAL DEFECT MEANS
FAILURE TO FOLLOW CONTRACTED PROCEDURES IN ACCESSING  SERVICES,  INCLUD-
ING,  BUT  NOT  LIMITED  TO, FAILURE TO REQUEST APPROPRIATE OR NECESSARY
AUTHORIZATION OF AN ADMISSION OR PROVISION OF SERVICES  AND  FAILURE  TO
PROVIDE  PROPER  NOTIFICATION  OF  AN  ADMISSION  OR  THE  PROVISION  OF
SERVICES.
  (2) NOTHING IN THIS SUBSECTION SHALL PRECLUDE A GENERAL  HOSPITAL  AND
AN  INSURER,  OR  AN  ORGANIZATION  OR CORPORATION LICENSED OR CERTIFIED
PURSUANT TO ARTICLE FORTY-THREE OR FORTY-SEVEN OF THIS CHAPTER OR  ARTI-
CLE  FORTY-FOUR OF THE PUBLIC HEALTH LAW, FROM AGREEING TO REDUCTIONS IN
PAYMENT FOR ADMINISTRATIVE  OR  TECHNICAL  DEFECTS;  PROVIDED,  HOWEVER,
THAT:  (I)  NO  REDUCTION SHALL BE IMPOSED IF AT LEAST NINETY PERCENT OF
THE CLAIMS OTHERWISE SUBMITTED BY THE GENERAL HOSPITAL TO THAT  INSURER,
ORGANIZATION  OR CORPORATION IN THE PREVIOUS CALENDAR YEAR HAD NO ADMIN-
ISTRATIVE OR TECHNICAL DEFECT, (II) NO REDUCTION SHALL BE IMPOSED IF THE
SERVICE WAS PREAUTHORIZED BY SUCH INSURER, ORGANIZATION OR  CORPORATION,
OR  IF  THE  PATIENT'S  INSURANCE  COVERAGE WAS NOT KNOWN TO THE GENERAL

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.

Co-Sponsors

S7071B (ACTIVE) - Details

See Assembly Version of this Bill:
A9946B
Law Section:
Insurance Law
Laws Affected:
Amd §§3217-b, 4325 & 3224-a, Ins L; amd §4406-c, Pub Health L
Versions Introduced in 2011-2012 Legislative Session:
A9946B, S7071, S7071A

S7071B (ACTIVE) - Summary

Relates to denial of health insurance claims.

S7071B (ACTIVE) - Sponsor Memo

S7071B (ACTIVE) - Bill Text download pdf

                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 7071--B

                            I N  S E N A T E

                             April 27, 2012
                               ___________

Introduced  by  Sens.  HANNON, LARKIN -- read twice and ordered printed,
  and when printed to  be  committed  to  the  Committee  on  Health  --
  reported  favorably from said committee and committed to the Committee
  on Finance -- committee discharged, bill amended, ordered reprinted as
  amended and recommitted to said  committee  --  committee  discharged,
  bill  amended,  ordered  reprinted  as amended and recommitted to said
  committee

AN ACT to amend the insurance law and the public health law, in relation
  to denial of claims

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1.  Section 3217-b of the insurance law is amended by adding a
new subsection (j) to read as follows:
  (J) (1) AN INSURER SHALL NOT DENY PAYMENT TO A GENERAL HOSPITAL CERTI-
FIED  PURSUANT  TO  ARTICLE  TWENTY-EIGHT OF THE PUBLIC HEALTH LAW FOR A
CLAIM FOR MEDICALLY NECESSARY INPATIENT SERVICES RESULTING FROM AN EMER-
GENCY ADMISSION PROVIDED BY A GENERAL HOSPITAL SOLELY ON THE BASIS  THAT
THE  GENERAL  HOSPITAL  DID  NOT  TIMELY  NOTIFY  SUCH  INSURER THAT THE
SERVICES HAD BEEN PROVIDED.
  (2) NOTHING IN THIS SUBSECTION SHALL PRECLUDE A GENERAL  HOSPITAL  AND
AN  INSURER  FROM  AGREEING TO REQUIREMENTS FOR TIMELY NOTIFICATION THAT
MEDICALLY NECESSARY  INPATIENT  SERVICES  RESULTING  FROM  AN  EMERGENCY
ADMISSION HAVE BEEN PROVIDED AND TO REDUCTIONS IN PAYMENT FOR FAILURE TO
TIMELY  NOTIFY;  PROVIDED,  HOWEVER THAT: (I) ANY REQUIREMENT FOR TIMELY
NOTIFICATION MUST PROVIDE FOR A REASONABLE EXTENSION OF  TIMEFRAMES  FOR
NOTIFICATION  FOR  EMERGENCY  SERVICES  PROVIDED  ON WEEKENDS OR FEDERAL
HOLIDAYS, (II) ANY AGREED TO REDUCTION IN PAYMENT FOR FAILURE TO  TIMELY
NOTIFY  SHALL  NOT  EXCEED  THE LESSER OF TWO THOUSAND DOLLARS OR TWELVE
PERCENT OF THE PAYMENT AMOUNT OTHERWISE DUE FOR THE  SERVICES  PROVIDED,
AND (III) ANY AGREED TO REDUCTION IN PAYMENT FOR FAILURE TO TIMELY NOTI-
FY SHALL NOT BE IMPOSED IF THE PATIENT'S INSURANCE COVERAGE COULD NOT BE
DETERMINED  BY  THE  HOSPITAL  AFTER  REASONABLE EFFORTS AT THE TIME THE
INPATIENT SERVICES WERE PROVIDED.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD15258-07-2

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