S T A T E O F N E W Y O R K
________________________________________________________________________
199--A
2011-2012 Regular Sessions
I N A S S E M B L Y
(PREFILED)
January 5, 2011
___________
Introduced by M. of A. LANCMAN -- read once and referred to the Commit-
tee on Insurance -- 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 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:
Section 1. Short title. This act shall be known and may be cited as
the "health insurance preauthorization disclosure act".
S 2. 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 OR PRECERTIFICATION FROM SUCH HEALTH CARE
INSURANCE COMPANY. 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 INSURANCE COMPANY 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 OR PRECERTIFICATION BY THE HEALTH CARE
INSURANCE COMPANY. NO HEALTH CARE TREATMENT OR SERVICE SHALL BE ADDED TO
THE LIST OF SERVICES REQUIRED PRE-AUTHORIZATION OR PRECERTIFICATION
UNLESS THE HEALTH CARE INSURANCE COMPANY PROVIDES A MINIMUM OF NINETY
DAYS NOTICE TO PARTICIPATING PHYSICIANS AND HEALTH CARE PROVIDERS.
S 3. The public health 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.
LBD01359-03-1
A. 199--A 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 OR PRECER-
TIFICATION FROM SUCH HEALTH CARE PLAN. SUCH LIST SHALL BE DEVELOPED
BASED UPON CONSULTATION WITH MEDICAL GUIDELINES DEVELOPED BY THE RELE-
VANT MEDICAL SPECIALTY ORGANIZATION AND IN CONSULTATION WITH APPROPRI-
ATELY 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 OR PRECERTIFICATION BY THE
HEALTH CARE PLAN. NO HEALTH CARE SERVICE SHALL BE ADDED TO THE LIST OF
SERVICES REQUIRING PRE-AUTHORIZATION OR PRECERTIFICATION UNLESS THE
HEALTH CARE PLAN PROVIDES A MINIMUM OF NINETY DAYS NOTICE TO PARTICIPAT-
ING HEALTH CARE PROVIDERS.
S 4. The insurance 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 OR PRECER-
TIFICATION FROM SUCH HEALTH CARE PLAN. SUCH LIST SHALL BE DEVELOPED
BASED UPON CONSULTATION WITH MEDICAL GUIDELINES DEVELOPED BY THE RELE-
VANT MEDICAL SPECIALTY ORGANIZATION AND IN CONSULTATION WITH APPROPRI-
ATELY 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 OR PRECERTIFICATION BY THE
HEALTH CARE PLAN. NO HEALTH CARE SERVICE SHALL BE ADDED TO THE LIST OF
SERVICES REQUIRING PRE-AUTHORIZATION OR PRECERTIFICATION UNLESS THE
HEALTH CARE PLAN PROVIDES A MINIMUM OF NINETY DAYS NOTICE TO PARTICIPAT-
ING HEALTH CARE PROVIDERS.
S 5. 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.