senate Bill S5834

Signed By Governor
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 - Signed by Governor


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

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Actions

view actions (11)
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 20, 2013 referred to health
delivered to assembly
passed senate
ordered to third reading cal.1551
Jun 17, 2013 referred to rules

Co-Sponsors

S5834 - Details

See Assembly Version of this Bill:
A2691B
Law Section:
Public Health Law
Laws Affected:
Amd §§4903 & 4914, Pub Health L; amd §§4903 & 4914, Ins L
Versions Introduced in Previous Legislative Sessions:
2011-2012: A659
2009-2010: A792A

S5834 - Summary

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

S5834 - Sponsor Memo

S5834 - Bill Text download pdf

                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  5834

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                              June 17, 2013
                               ___________

Introduced  by  Sens.  HANNON, LARKIN -- read twice and ordered printed,
  and when printed to be committed to the Committee on Rules

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-
ant  to  section  2719  of  the  Public  Health Service Act, 42 U.S.C. S
300gg-19. Where applicable, the enrollee's health  care  provider  shall
have  [forty-five]  SIXTY  days to initiate an external appeal after the
enrollee or the enrollee's health care provider, as applicable, receives
notice from the health care plan,  or  such  plan's  utilization  review
agent if applicable, of a final adverse determination or denial or after

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD01431-06-3

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