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Assembly Bill A10268A

2015-2016 Legislative Session

Limits denial of coverage of additional treatment related to health care services for which pre-authorization is required and was granted

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Archive: Last Bill Status - In Senate Committee Rules Committee

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Bill Amendments

2015-A10268 - Details

See Senate Version of this Bill:
S7558
Current Committee:
Senate Rules
Law Section:
Insurance Law
Laws Affected:
Amd §3238, Ins L
Versions Introduced in Other Legislative Sessions:
2017-2018: A1129, S3568
2019-2020: A2880, S1394, S5328

2015-A10268 - Summary

Limits denial of coverage of additional treatment related to health care services for which pre-authorization is required and was granted.

2015-A10268 - Bill Text download pdf 

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

                                  10268

                          I N  A S S E M B L Y

                              May 19, 2016
                               ___________

Introduced by M. of A. HUNTER -- read once and referred to the Committee
  on Insurance

AN  ACT to amend the insurance law, in relation to preventing plans from
  denying treatment due to lack of pre-authorization

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

  Section  1.  Section  3238 of the insurance law is amended by adding a
new subsection (c-1) to read as follows:
  (C-1) IF A HEALTH PLAN DENIES PAYMENT FOR THE TREATMENT OF  CONCURRENT
SYMPTOMS  OR  SIDE  EFFECTS  DUE  TO  LACK OF PRE-AUTHORIZATION AND SUCH
TREATMENT IS RENDERED AT THE SAME TIME AS  A  HEALTH  CARE  SERVICE  FOR
WHICH  PRE-AUTHORIZATION  WAS  REQUIRED AND RECEIVED, UPON THE APPEAL OF
THE THE DENIAL, THE DENIAL OF ANY SUCH SERVICE SHALL BE UPHELD  ONLY  IF
IT IS DETERMINED THAT:
  (1) THE TREATMENT IS NOT A COVERED BENEFIT;
  (2) THE TREATMENT WAS NOT MEDICALLY NECESSARY PURSUANT TO SECTION FOUR
THOUSAND NINE HUNDRED FOUR OF THIS CHAPTER OR SECTION FOUR THOUSAND NINE
HUNDRED FOUR OF THE PUBLIC HEALTH LAW;
  (3)  THE  TREATMENT  WAS  EXPERIMENTAL  OR INVESTIGATIONAL PURSUANT TO
SECTION FOUR THOUSAND NINE HUNDRED FOUR OF THIS CHAPTER OR SECTION  FOUR
THOUSAND NINE HUNDRED FOUR OF THE PUBLIC HEALTH LAW; OR
  (4)  ON  OF  THE CONDITIONS SET FORTH IN PARAGRAPHS ONE THROUGH SIX OF
SUBSECTION (A) OF THIS SECTION IS MET.
  S 2. This act shall take effect immediately.




 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD15457-02-6

2015-A10268A (ACTIVE) - Details

See Senate Version of this Bill:
S7558
Current Committee:
Senate Rules
Law Section:
Insurance Law
Laws Affected:
Amd §3238, Ins L
Versions Introduced in Other Legislative Sessions:
2017-2018: A1129, S3568
2019-2020: A2880, S1394, S5328

2015-A10268A (ACTIVE) - Summary

Limits denial of coverage of additional treatment related to health care services for which pre-authorization is required and was granted.

2015-A10268A (ACTIVE) - Bill Text download pdf 

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

                                10268--A

                          I N  A S S E M B L Y

                              May 19, 2016
                               ___________

Introduced by M. of A. HUNTER -- read once and referred to the Committee
  on  Insurance -- committee discharged, bill amended, ordered reprinted
  as amended and recommitted to said committee

AN ACT to amend the insurance law, in relation to denial of coverage  of
  treatment  related to health care services for which pre-authorization
  was granted

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

  Section  1.  Section  3238 of the insurance law is amended by adding a
new subsection (c-1) to read as follows:
  (C-1) IF A HEALTH PLAN DENIES PAYMENT FOR THE TREATMENT OF  CONCURRENT
SYMPTOMS  OR  SIDE  EFFECTS  DUE  TO  LACK OF PRE-AUTHORIZATION AND SUCH
TREATMENT IS RENDERED AT THE SAME TIME AS  A  HEALTH  CARE  SERVICE  FOR
WHICH  PRE-AUTHORIZATION  WAS  REQUIRED AND RECEIVED, UPON THE APPEAL OF
THE DENIAL, THE DENIAL OF ANY SUCH SERVICE SHALL BE UPHELD ONLY IF IT IS
DETERMINED THAT:
  (1) THE TREATMENT IS NOT A COVERED BENEFIT;
  (2) THE TREATMENT WAS NOT MEDICALLY NECESSARY PURSUANT TO SECTION FOUR
THOUSAND NINE HUNDRED FOUR OF THIS CHAPTER OR SECTION FORTY-NINE HUNDRED
FOUR OF THE PUBLIC HEALTH LAW;
  (3) THE TREATMENT WAS  EXPERIMENTAL  OR  INVESTIGATIONAL  PURSUANT  TO
SECTION  FOUR  THOUSAND  NINE  HUNDRED  FOUR  OF THIS CHAPTER OR SECTION
FORTY-NINE HUNDRED FOUR OF THE PUBLIC HEALTH LAW; OR
  (4) ONE OF THE CONDITIONS SET FORTH IN PARAGRAPHS ONE THROUGH  SIX  OF
SUBSECTION (A) OF THIS SECTION IS MET.
  S  2.  This  act shall take effect on the ninetieth day after it shall
have become a law.



 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD15457-03-6

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