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 |
Jun 18, 2012 |
amend (t) and recommit to finance |
Jun 13, 2012 |
print number 7071a |
Jun 13, 2012 |
amend (t) and recommit to finance |
May 22, 2012 |
reported and committed to finance |
Apr 27, 2012 |
referred to health |
Senate Bill S7071
Signed By Governor2011-2012 Legislative Session
Sponsored By
(R, C, IP) Senate District
Archive: Last Bill Status Via A9946 - Signed by Governor
- 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
Votes
Bill Amendments
co-Sponsors
(R, C) Senate District
2011-S7071 - Details
- See Assembly Version of this Bill:
- A9946
- Law Section:
- Public Health Law
- Laws Affected:
- Amd §§4903, 4914, 4905 & 4902, Pub Health L; amd §§4903, 3224-a, 4914, 4905 & 4902, Ins L
2011-S7071 - Sponsor Memo
BILL NUMBER:S7071 REVISED 05/22/12 TITLE OF BILL: An act to amend the public health law and the insurance law, in relation to utilization review and denial of claims PURPOSE: This bill amends the insurance and public health law in order to address certain health plan practices and the changing marketplace. SUMMARY OF PROVISIONS: Sections 1 and 2 amend subdivision 7 of section 4903 of the public health law, and subsection (g) of section 4903 of the insurance law, to ensure that the failure of a utilization review agent to make a determination would represent an approved claim. Section 3 amends section 3224-a of the insurance law by adding a new subsection (i) to prevent technical denials for compliant hospitals. Section 4 amends subsection (b) of the insurance law to prevent unilateral coding adjustments. Sections 5 and 6 amend subsection (1) of paragraph b of section 4914 of the insurance law, and paragraph (a) of subdivision 2 of section 4914 of the public health law, to extend the external appeal provider
2011-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
(R, C) Senate District
2011-S7071A - Details
- See Assembly Version of this Bill:
- A9946
- Law Section:
- Public Health Law
- Laws Affected:
- Amd §§4903, 4914, 4905 & 4902, Pub Health L; amd §§4903, 3224-a, 4914, 4905 & 4902, Ins L
2011-S7071A - Sponsor Memo
BILL NUMBER:S7071A TITLE OF BILL: An act to amend the insurance law, in relation to denial of claims PURPOSE: This bill amends the insurance law in order to address certain health plan practices and the changing marketplace. SUMMARY OF PROVISIONS: Section 1 amends section 3224-a of the insurance law by adding a new subsection (i) to prevent technical denials for compliant hospitals. Section 2 amends subsection (b) of section 3224-a of the insurance law to prevent unilateral coding adjustments JUSTIFICATION: This bill is intended to address certain health plan practices that result in unfair and unilateral reductions of payments and claims denials. This bill strikes a balance, as it preserves all health plan rights to review medical necessity, utilization of services, and claims payment processing but in a manner that provides fairness to providers and a remedy when certain health plans abuse or misapply existing policies.
2011-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
(R, C) Senate District
2011-S7071B (ACTIVE) - Details
- See Assembly Version of this Bill:
- A9946
- Law Section:
- Public Health Law
- Laws Affected:
- Amd §§4903, 4914, 4905 & 4902, Pub Health L; amd §§4903, 3224-a, 4914, 4905 & 4902, Ins L
2011-S7071B (ACTIVE) - Sponsor Memo
BILL NUMBER:S7071B TITLE OF BILL: An act to amend the insurance law and the public health law, in relation to denial of claims PURPOSE: This bill amends the insurance law and the public health law in order to address certain health plan practices and the changing marketplace. SUMMARY OF PROVISIONS: Section 1 amends section 3217-b of the insurance law by adding a new subsection (j); section 2 amends section 4325 of the insurance law by adding a new subdivision (k); and section 3 of the bill amends section 4406-c of the public health law by adding a new subdivision 8. These amendments prevent insurers and health plans from denying payment to a general hospital for a claim for medically necessary inpatient services resulting from an emergency admission solely on the basis that the hospital did not timely notify the insurer or plan that the services had been provided. Section 4 amends section 3224-a of the insurance law by adding a new subsection (i) to prevent unilateral coding adjustments. JUSTIFICATION:
2011-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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