assembly Bill A2880B

Signed By Governor
2019-2020 Legislative Session

Relates to denial of coverage of additional or alternative services or procedures related to health care services for which pre-authorization was granted or did not require pre-authorization; repealer

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Sponsored By

Current Bill Status Via S5328 - 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 (19)
Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Dec 12, 2019 signed chap.640
Dec 06, 2019 delivered to governor
Jun 19, 2019 returned to senate
passed assembly
ordered to third reading cal.493
substituted for a2880b
Jun 19, 2019 substituted by s5328a
Jun 14, 2019 amended on third reading 2880b
Jun 11, 2019 amended on third reading (t) 2880a
Jun 11, 2019 vote reconsidered - restored to third reading
returned to assembly
recalled from senate
Jun 04, 2019 referred to rules
delivered to senate
passed assembly
May 30, 2019 advanced to third reading cal.493
reported
May 21, 2019 reported referred to codes
Jan 28, 2019 referred to insurance

A2880 - Details

See Senate Version of this Bill:
S5328
Law Section:
Insurance Law
Laws Affected:
Rpld & add §3238 sub§ (c), Ins L
Versions Introduced in Other Legislative Sessions:
2015-2016: A10268, S7558
2017-2018: A1129, S3568

A2880 - Summary

Limits denial of coverage of additional or alternative services or procedures related to health care services for which pre-authorization was granted or did not require pre-authorization.

A2880 - Bill Text download pdf


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

                                  2880

                       2019-2020 Regular Sessions

                          I N  A S S E M B L Y

                            January 28, 2019
                               ___________

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.
                                                           LBD04761-01-9

A2880A - Details

See Senate Version of this Bill:
S5328
Law Section:
Insurance Law
Laws Affected:
Rpld & add §3238 sub§ (c), Ins L
Versions Introduced in Other Legislative Sessions:
2015-2016: A10268, S7558
2017-2018: A1129, S3568

A2880A - Summary

Limits denial of coverage of additional or alternative services or procedures related to health care services for which pre-authorization was granted or did not require pre-authorization.

A2880A - Bill Text download pdf


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

                                 2880--A
                                                        Cal. No. 493

                       2019-2020 Regular Sessions

                          I N  A S S E M B L Y

                            January 28, 2019
                               ___________

Introduced by M. of A. HUNTER -- read once and referred to the Committee
  on  Insurance  --  reported  and referred to the Committee on Codes --
  advanced to a third reading, passed by Assembly and delivered  to  the
  Senate,  recalled  from  the  Senate, vote reconsidered, bill amended,
  ordered reprinted, retaining its place on the order of third reading

AN ACT to amend the insurance law, in relation to denial of coverage  of
  additional  or  alternative  services  or procedures related to health
  care services for which  pre-authorization  was  granted  or  did  not
  require  pre-authorization;  and  to repeal certain provisions of such
  law relating thereto

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

  Section  1.    Subsection  (c) of section 3238 of the insurance law is
REPEALED and a new subsection (c) is added to read as follows:
  (C)(1) IF A HEALTH CARE PROVIDER, WHILE PROVIDING A SERVICE OR  PROCE-
DURE  TO  TREAT  A PATIENT, DETERMINES THAT AN ADDITIONAL OR ALTERNATIVE
SERVICE OR PROCEDURE IS NECESSARY AS PART OF SUCH TREATMENT, AND IN  THE
SOLE  JUDGMENT OF THE HEALTH CARE PROVIDER IT IS NOT ADVISABLE TO INTER-
RUPT THE PROVISION OF CARE TO THE PATIENT IN ORDER TO OBTAIN PRE-AUTHOR-
IZATION FROM A HEALTH PLAN FOR THE ADDITIONAL OR ALTERNATIVE SERVICE  OR
PROCEDURE, A DENIAL OF PAYMENT FOR THE ADDITIONAL OR ALTERNATIVE SERVICE
OR  PROCEDURE DUE TO LACK OF PRE-AUTHORIZATION SHALL BE UPHELD ON APPEAL
ONLY IF IT IS DETERMINED THAT:
  (I) THE ADDITIONAL OR  ALTERNATIVE  SERVICE  OR  PROCEDURE  IS  NOT  A
COVERED BENEFIT;
  (II)  THE  ADDITIONAL  OR  ALTERNATIVE  SERVICE  OR  PROCEDURE 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;
  (III) THE ADDITIONAL OR ALTERNATIVE SERVICE OR  PROCEDURE  WAS  EXPER-
IMENTAL  OR  INVESTIGATIONAL  PURSUANT  TO  SECTION  FOUR  THOUSAND NINE

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets

A2880B (ACTIVE) - Details

See Senate Version of this Bill:
S5328
Law Section:
Insurance Law
Laws Affected:
Rpld & add §3238 sub§ (c), Ins L
Versions Introduced in Other Legislative Sessions:
2015-2016: A10268, S7558
2017-2018: A1129, S3568

A2880B (ACTIVE) - Summary

Limits denial of coverage of additional or alternative services or procedures related to health care services for which pre-authorization was granted or did not require pre-authorization.

A2880B (ACTIVE) - Bill Text download pdf


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

                                 2880--B
                                                        Cal. No. 493

                       2019-2020 Regular Sessions

                          I N  A S S E M B L Y

                            January 28, 2019
                               ___________

Introduced by M. of A. HUNTER -- read once and referred to the Committee
  on  Insurance  --  reported  and referred to the Committee on Codes --
  advanced to a third reading, passed by Assembly and delivered  to  the
  Senate,  recalled  from  the  Senate, vote reconsidered, bill amended,
  ordered reprinted, retaining its place on the order of  third  reading
  --  again  amended  on third reading, ordered reprinted, retaining its
  place on the order of third reading

AN ACT to amend the insurance law, in relation to denial of coverage  of
  additional  or  related  services or procedures related to health care
  services for which pre-authorization was granted or  did  not  require
  pre-authorization; and to repeal certain provisions of such law relat-
  ing thereto

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

  Section 1.  Subsection (c) of section 3238 of  the  insurance  law  is
REPEALED and a new subsection (c) is added to read as follows:
  (C)(1)  IF A HEALTH CARE PROVIDER, WHILE PROVIDING A SERVICE OR PROCE-
DURE TO TREAT A PATIENT, DETERMINES  THAT  PROVIDING  AN  ADDITIONAL  OR
RELATED  SERVICE OR PROCEDURE, SUCH AS A SERVICE OR PROCEDURE TO ADDRESS
A CO-MORBID CONDITION, IS IMMEDIATELY NECESSARY AS PART OF  SUCH  TREAT-
MENT,  AND  IN THE CLINICAL JUDGMENT OF THE HEALTH CARE PROVIDER IT IS A
MEDICALLY TIMELY SERVICE AND IT WOULD  NOT  BE  MEDICALLY  ADVISABLE  TO
INTERRUPT  THE  PROVISION OF CARE TO THE PATIENT IN ORDER TO OBTAIN PRE-
AUTHORIZATION FROM A HEALTH PLAN FOR THE ADDITIONAL OR  RELATED  SERVICE
OR  PROCEDURE, A DENIAL OF PAYMENT FOR THE ADDITIONAL OR RELATED SERVICE
OR PROCEDURE DUE TO LACK OF PRE-AUTHORIZATION SHALL BE UPHELD ON  APPEAL
ONLY IF IT IS DETERMINED THAT:
  (I)  THE  ADDITIONAL  OR RELATED SERVICE OR PROCEDURE IS NOT A COVERED
BENEFIT;

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD04761-07-9

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