senate Bill S6459

2013-2014 Legislative Session

Shortens time frames during which an insurer has to determine whether a pre-authorization request is medically necessary

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Archive: Last Bill Status - In Committee


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

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Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Jan 27, 2014 referred to insurance

S6459 - Bill Details

See Assembly Version of this Bill:
A8442
Current Committee:
Senate Insurance
Law Section:
Insurance Law
Laws Affected:
Amd §4903, Ins L; amd §4903, Pub Health L

S6459 - Bill Texts

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Shortens time frames during which an insurer has to determine whether a pre-authorization request is medically necessary from three business days to three days.

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BILL NUMBER:S6459

TITLE OF BILL: An act to amend the insurance law and the public health
law, in relation to shortening time frames during which an insurer has
to determine whether a pre-authorization request is medically necessary

PURPOSE: To shorten time frames during which an insurer has to deter-
mine whether a pre-authorization request is medically necessary.

SUMMARY OF PROVISIONS:

Section 1. Amends Subsection (b) of section 4903 of the insurance law to
require that a utilization review agent shall make a determination
involving health care services which require pre-authorization and
provide notice of the determination to the insured by telephone and in
writing within three days, rather than three business days, of receipt
of the necessary information.

Section 2. Amends subdivision 2 of section 4903 of the public health law
to require that a utilization review agent shall make a utilization
review determination involving health care services which require pre-
authorization and provide notice of a determination to the enrollee by
telephone and in writing within three days of receipt of the necessary
information.

Section 3. Effective date.

JUSTIFICATION: Hospitalized patients must receive pre-authorization
from their insurance companies in order to have some health care
services covered, including the transfer of a patient from a hospital to
a nursing home or rehabilitation center. Currently, the timeframe within
which insurance companies must issue this determination is three busi-
ness days. However, this time frame is too long for many patients,
particularly over long holiday weekends. During holiday weekends, the
patient must wait an additional three to four days in the hospital with-
out beginning to recover.

The current time frame prevents many patients from leaving the hospital
as they prepare to be transferred to a rehabilitation facility. These
rehabilitation facilities are often prepared to accept the patient, but
cannot do so without pre-authorization from the insurance company.

Many of these insurance companies already have customer service repre-
sentatives available during these days to answer questions from individ-
uals or to sign up individuals for coverage. This bill would shorten the
time frame within which approval is required so that hospitalized
patients can begin the healing process in a timely manner.

LEGISLATIVE HISTORY: New bill.

FISCAL IMPLICATIONS: None.

EFFECTIVE DATE: This act shall take effect on the same date and in the
same manner as section 5 of chapter 514 of the laws of 2013, takes
effect.

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

                                  6459

                            I N  S E N A T E

                            January 27, 2014
                               ___________

Introduced  by Sen. CARLUCCI -- read twice and ordered printed, and when
  printed to be committed to the Committee on Insurance

AN ACT to amend the insurance law and the public health law, in relation
  to shortening time frames during which an  insurer  has  to  determine
  whether a pre-authorization request is medically necessary

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Subsection (b) of section 4903 of  the  insurance  law,  as
amended  by  chapter  514  of  the  laws  of 2013, is amended to read as
follows:
  (b) A utilization review agent shall make a utilization review  deter-
mination  involving health care services which require pre-authorization
and provide notice of a determination to the insured or insured's desig-
nee and the insured's health care provider by telephone and  in  writing
within three [business] days of receipt of the necessary information. 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.  Subdivision  2  of  section  4903  of the public health law, as
amended by chapter 514 of the laws  of  2013,  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  infor-
mation.  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  3.  This  act  shall  take  effect on the same date and in the same
manner as section 5 of chapter 514 of the laws of 2013, takes effect.


 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD13491-01-4

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