|Assembly Actions - Lowercase
Senate Actions - UPPERCASE
|Jan 08, 2014||referred to health|
|Jun 21, 2013||committed to rules|
|Jun 10, 2013||advanced to third reading|
|Jun 05, 2013||2nd report cal.|
|Jun 04, 2013||1st report cal.1126|
|May 15, 2013||referred to health|
senate Bill S5256
Archive: Last Bill Status - In Committee
- In Committee
- On Floor Calendar
- Passed Senate
- Passed Assembly
- Delivered to Governor
- Signed/Vetoed by Governor
S5256 - Details
- Current Committee:
- Law Section:
- Public Health Law
- Laws Affected:
- Amd §§4903, 4905 & 4914, Pub Health L; amd §§4903, 4905 & 4914, Ins L
S5256 - Summary
Regulates the scope, manner and performance of review of claims by utilization review agents.
S5256 - Sponsor Memo
BILL NUMBER:S5256 TITLE OF BILL: An act to amend the public health law and the insurance law, in relation to approvals by a utilization review agent PURPOSE: This bill amends the public health and insurance laws related to utilization review and external appeals. SUMMARY OF PROVISIONS: Section 1 amends of § 4903 of the public health law to ensure that the failure of a utilization review agent to make a determination shall be deemed an approved claim. Section 2 adds a new paragraph (b) of Subdivision 5 of § 4905 of the public health law to require that utilization review agents substantiate pre-authorizations in writing, which may be electronic. Sections 3 amends § 4914 of the public health law to extend the external appeal provider timeframe from 45 days to 4 months in order to conform with recent changes to related patient timeframes. Sections 4, 5 and 6 make the same changes as Sections 1, 2 and 3 of the bill in the insurance law.
S5256 - Bill Text download pdf
S T A T E O F N E W Y O R K ________________________________________________________________________ 5256 2013-2014 Regular Sessions I N S E N A T E May 15, 2013 ___________ 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 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. S 3. 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: EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD01431-02-3
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