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Assembly Bill A1129

2017-2018 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 Insurance Committee

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2017-A1129 (ACTIVE) - Details

See Senate Version of this Bill:
S3568
Current Committee:
Senate Insurance
Law Section:
Insurance Law
Laws Affected:
Amd §3238, Ins L
Versions Introduced in Other Legislative Sessions:
2015-2016: A10268, S7558
2019-2020: A2880, S1394, S5328

2017-A1129 (ACTIVE) - Summary

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

2017-A1129 (ACTIVE) - Bill Text download pdf 

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1129
 
                        2017-2018 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 10, 2017
                                ___________
 
 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 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.
   § 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.
                                                            LBD02613-01-7

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