senate Bill S5256

2013-2014 Legislative Session

Regulates the scope, manner and performance of review of claims by utilization review agents

download bill text pdf

Sponsored By

Archive: Last Bill Status - In Senate Committee


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor

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Actions

view actions (6)
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

Co-Sponsors

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

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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