Assembly Actions -
Lowercase Senate Actions - UPPERCASE |
|
---|---|
Feb 27, 2012 |
referred to insurance |
Senate Bill S6551
2011-2012 Legislative Session
Sponsored By
(R, C, IP) Senate District
Archive: Last Bill Status - In Senate Committee Insurance Committee
- Introduced
-
- In Committee Assembly
- In Committee Senate
-
- On Floor Calendar Assembly
- On Floor Calendar Senate
-
- Passed Assembly
- Passed Senate
- Delivered to Governor
- Signed By Governor
Actions
2011-S6551 (ACTIVE) - Details
- Current Committee:
- Senate Insurance
- Law Section:
- Insurance Law
- Laws Affected:
- Amd §§3224-a & 4914, Ins L; amd §4914, Pub Health L
2011-S6551 (ACTIVE) - Sponsor Memo
BILL NUMBER:S6551 TITLE OF BILL: An act to amend the insurance law, in relation to prohibiting providers of health care benefits from denying payment of claims for medically necessary service for failure to provide timely notice; and to amend the insurance law and the public health law, in relation to expanding the time limit to initiate an external appeal by an insureds health care provider to four months PURPOSE OR GENERAL IDEA OF BILL: To prohibit the denial of claims for medically necessary services based solely upon a hospitals failure to timely notify the insurer, organiza- tion or corporation providing coverage that the service has been provided, unless the hospital and the insurer, organization or corpo- ration agree to such notification requirements; and to extend the time in which a provider may seek an external appeal. SUMMARY OF PROVISIONS: Section one amends Insurance Law §3224-a to provide that an insurer, or an organization or corporation certified pursuant to Article 43 or 47 of this chapter, or Article 44 of the PHL shall not deny payment of claims for medically necessary services provided by a general hospital certi- fied pursuant to Article 28 of the PHL on the basis that the hospital did not timely notify such insurer, organization or corporation that the services had been provided. This section shall not preclude a hospital
2011-S6551 (ACTIVE) - Bill Text download pdf
S T A T E O F N E W Y O R K ________________________________________________________________________ 6551 I N S E N A T E February 27, 2012 ___________ Introduced by Sen. HANNON -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance AN ACT to amend the insurance law, in relation to prohibiting providers of health care benefits from denying payment of claims for medically necessary service for failure to provide timely notice; and to amend the insurance law and the public health law, in relation to expanding the time limit to initiate an external appeal by an insureds health care provider to four months 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) AN INSURER, OR AN ORGANIZATION OR CORPORATION LICENSED OR CERTIFIED PURSUANT TO ARTICLE FORTY-THREE OR 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 THAT THE HOSPITAL DID NOT TIMELY NOTIFY SUCH INSURER, ORGANIZATION OR CORPORATION THAT THE SERVICE HAD BEEN PROVIDED. (2) NOTHING IN THIS SUBSECTION SHALL PRECLUDE A HOSPITAL AND AN INSUR- ER, OR AN ORGANIZATION OR CORPORATION LICENSED OR CERTIFIED PURSUANT TO ARTICLE FORTY-THREE OR FORTY-SEVEN OF THIS CHAPTER OR ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW FROM AGREEING TO REQUIREMENTS FOR TIMELY NOTIFICATION THAT A SERVICE HAS BEEN PROVIDED OR PAYMENT PENALTIES FOR UNTIMELY NOTIFICATION; PROVIDED, HOWEVER, THAT ANY AGREED TO REDUCTIONS IN PAYMENT FOR CLAIMS FOR SERVICES FOR WHICH THE HOSPITAL FAILS TO TIME- LY NOTIFY SHALL NOT: (I) EXCEED TWELVE PERCENT OF THE PAYMENT AMOUNT OTHERWISE DUE FROM SUCH INSURER, ORGANIZATION OR CORPORATION FOR THE SERVICES PROVIDED, AND (II) BE IMPOSED IF THE SERVICE WAS PREAUTHORIZED BY SUCH INSURER, ORGANIZATION OR CORPORATION, OR IF THE PATIENT'S INSUR- ANCE COVERAGE WAS NOT KNOWN TO THE HOSPITAL UNTIL AFTER THE PATIENT WAS DISCHARGED. EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD14716-01-2
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