Assembly Actions -
Lowercase Senate Actions - UPPERCASE |
|
---|---|
Nov 13, 2013 |
signed chap.514 |
Nov 01, 2013 |
delivered to governor |
Jun 21, 2013 |
returned to senate passed assembly ordered to third reading cal.20 substituted for a2691b |
Jun 21, 2013 |
substituted by s5834 |
Jun 17, 2013 |
amended on third reading 2691b |
Jun 17, 2013 |
vote reconsidered - restored to third reading returned to assembly recalled from senate |
Jun 11, 2013 |
recommitted to health returned to senate repassed assembly |
Jun 03, 2013 |
amended on third reading 2691a |
Jun 03, 2013 |
vote reconsidered - restored to third reading returned to assembly recalled from senate |
Feb 04, 2013 |
referred to health delivered to senate passed assembly |
Jan 31, 2013 |
advanced to third reading cal.20 |
Jan 29, 2013 |
reported |
Jan 17, 2013 |
referred to health |
Assembly Bill A2691B
Signed By Governor2013-2014 Legislative Session
Sponsored By
GOTTFRIED
Archive: Last Bill Status Via S5834 - 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
William Colton
Ellen C. Jaffee
multi-Sponsors
Micah Kellner
Michael Montesano
2013-A2691 - Details
2013-A2691 - Bill Text download pdf
S T A T E O F N E W Y O R K ________________________________________________________________________ 2691 2013-2014 Regular Sessions I N A S S E M B L Y January 17, 2013 ___________ Introduced by M. of A. GOTTFRIED, COLTON -- Multi-Sponsored by -- M. of A. KELLNER, MONTESANO -- read once and referred to the Committee on Health AN ACT to amend the public health law and the insurance law, in relation to approvals by a utilization review agent THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Paragraph (h) of subdivision 1 of section 4902 of the public health law, as added by chapter 705 of the laws of 1996, is amended to read as follows: (h) Establishment of a requirement that emergency services rendered to an enrollee shall not be subject to prior authorization nor shall reimbursement for such services be denied on retrospective review; provided, however, that such services are medically necessary to stabi- lize or treat an emergency condition. IN REVIEWING A DENIAL FOR COVER- AGE OF EMERGENCY SERVICES TO TREAT AN EMERGENCY MEDICAL CONDITION, THE UTILIZATION REVIEW AGENT SHALL TAKE THE FOLLOWING FACTORS INTO CONSIDER- ATION: (1) THE TIME OF DAY AND DAY OF THE WEEK THE CARE WAS PROVIDED; (2) THE PRESENTING SYMPTOMS, INCLUDING BUT NOT LIMITED TO, SEVERE PAIN, TO ENSURE THAT THE DECISION TO DENY REIMBURSEMENT FOR EMERGENCY SERVICE IS NOT MADE SOLELY ON THE BASIS OF THE FINAL DIAGNOSIS. S 2. 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 3. Subdivision 1 of section 4904 of the public health law, as added by chapter 705 of the laws of 1996, is amended to read as follows: EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD01431-01-3
co-Sponsors
William Colton
Ellen C. Jaffee
multi-Sponsors
Micah Kellner
Michael Montesano
2013-A2691A - Details
2013-A2691A - Bill Text download pdf
S T A T E O F N E W Y O R K ________________________________________________________________________ 2691--A Cal. No. 20 2013-2014 Regular Sessions I N A S S E M B L Y January 17, 2013 ___________ Introduced by M. of A. GOTTFRIED, COLTON, JAFFEE -- Multi-Sponsored by -- M. of A. KELLNER, MONTESANO -- read once and referred to the Committee on Health -- passed by Assembly and delivered to the Senate, recalled from the Senate, vote reconsidered, bill amended, ordered reprinted, retaining its place on the order of third reading AN ACT to amend the public health law and the insurance law, in relation to approvals by a utilization review agent 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. The opening paragraph of subdivision 5 of section 4905 of the public health law is designated paragraph (a) and a new paragraph (b) is added to read as follows: (B) WHENEVER A UTILIZATION REVIEW AGENT MAKES A VERBAL REPRESENTATION REGARDING PREAUTHORIZATION OR APPROVAL, THE UTILIZATION REVIEW AGENT SHALL IMMEDIATELY, BUT NOT LATER THAN WITHIN ONE BUSINESS DAY; SUPPLY THE PROVIDER WITH A WRITTEN CONFIRMATION OF THE APPROVAL BY EITHER: (I) SENDING A COPY OF SUCH APPROVAL THROUGH ELECTRONIC MAIL TO AN ADDRESS SPECIFIED BY THE PROVIDER; (II) SENDING A COPY OF SUCH APPROVAL THROUGH FACSIMILE TRANSMISSION TO A NUMBER SPECIFIED BY THE PROVIDER; OR (III) POSTING A COPY OF SUCH APPROVAL ON A SPECIFIC WEBPAGE OF THE INSURER'S WEBSITE TO WHICH THE PROVIDER HAS BEEN DIRECTED AND TO WHICH THE PROVIDER HAS BEEN GIVEN ACCESS SO THAT THE PROVIDER MAY IMMEDIATELY PRINT AND RETAIN A HARD COPY. EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD01431-03-3
co-Sponsors
William Colton
Ellen C. Jaffee
multi-Sponsors
Micah Kellner
Michael Montesano
Luis R. Sepúlveda
2013-A2691B (ACTIVE) - Details
2013-A2691B (ACTIVE) - Bill Text download pdf
S T A T E O F N E W Y O R K ________________________________________________________________________ 2691--B Cal. No. 20 2013-2014 Regular Sessions I N A S S E M B L Y January 17, 2013 ___________ Introduced by M. of A. GOTTFRIED, COLTON, JAFFEE -- Multi-Sponsored by -- M. of A. KELLNER, MONTESANO -- read once and referred to the Committee on Health -- passed by Assembly and delivered to the Senate, recalled from the Senate, vote reconsidered, bill amended, ordered reprinted, retaining its place on the order of third reading -- passed by Assembly and delivered to the Senate, recalled from the Senate, vote reconsidered, bill amended, ordered reprinted, retaining its place on the order of third reading AN ACT to amend the public health law and the insurance law, in relation to approvals by a utilization review agent THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Subdivision 2 of section 4903 of the public health law, as added by chapter 705 of the laws of 1996, is amended to read as follows: 2. A utilization review agent shall make a utilization review determi- nation involving health care services which require pre-authorization and provide notice of a determination to the enrollee or enrollee's designee and the enrollee's health care provider by telephone and in writing within three business days of receipt of the necessary informa- tion. TO THE EXTENT PRACTICABLE, SUCH WRITTEN NOTIFICATION TO THE ENROLLEE'S HEALTH CARE PROVIDER SHALL BE TRANSMITTED ELECTRONICALLY, IN A MANNER AND IN A FORM AGREED UPON BY THE PARTIES. S 2. Paragraph (a) of subdivision 2 of section 4914 of the public health law, as amended by chapter 219 of the laws of 2011, is amended to read as follows: (a) The enrollee shall have four months to initiate an external appeal after the enrollee receives notice from the health care plan, or such plan's utilization review agent if applicable, of a final adverse deter- mination or denial or after both the plan and the enrollee have jointly agreed to waive any internal appeal, or after the enrollee is deemed to have exhausted or is not required to complete any internal appeal pursu- EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted.
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