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 |
Senate Bill S5834
Signed By Governor2013-2014 Legislative Session
Sponsored By
(R, C, IP) Senate District
Archive: Last Bill Status - 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
co-Sponsors
(R, C) Senate District
2013-S5834 (ACTIVE) - Details
2013-S5834 (ACTIVE) - Sponsor Memo
BILL NUMBER:S5834 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 Subdivision 2 of § 4903 of the public health law to require written notification to the enrollee's health care provider be transmitted electronically, to the extent practicable, in a manner and form agreed to by the parties. Section 2 amends Subdivision 2 of § 4914 of the public health law to extend the external appeal provider timeframe from 45 days to 60 days. Sections 3 and 4 make the same changes as Sections 1 and 2 of the bill in the insurance law. Section 5 provides for an effective date of 7/1/14. JUSTIFICATION: This bill is intended to address certain health plan practices that result in unfair and unilateral reductions of payments and claims denials. This bill strikes a balance, as it preserves all
2013-S5834 (ACTIVE) - 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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