senate Bill S5328A

Signed By Governor
2019-2020 Legislative Session

Relates 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; repealer

download bill text pdf

Sponsored By

Current Bill Status - 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 (14)
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 18, 2019 referred to codes
delivered to assembly
passed senate
ordered to third reading cal.1509
committee discharged and committed to rules
Jun 14, 2019 print number 5328a
Jun 14, 2019 amend (t) and recommit to insurance
Apr 26, 2019 referred to insurance

S5328 - Details

See Assembly Version of this Bill:
A2880
Law Section:
Insurance Law
Laws Affected:
Rpld & add §3238 sub§ (c), Ins L
Versions Introduced in Other Legislative Sessions:
2015-2016: S7558, A10268
2017-2018: S3568, A1129

S5328 - Summary

Relates 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.

S5328 - Sponsor Memo

S5328 - Bill Text download pdf


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

                                  5328

                       2019-2020 Regular Sessions

                            I N  S E N A T E

                             April 26, 2019
                               ___________

Introduced  by  Sen. BRESLIN -- read twice and ordered printed, and when
  printed to be committed 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

Co-Sponsors

S5328A (ACTIVE) - Details

See Assembly Version of this Bill:
A2880
Law Section:
Insurance Law
Laws Affected:
Rpld & add §3238 sub§ (c), Ins L
Versions Introduced in Other Legislative Sessions:
2015-2016: S7558, A10268
2017-2018: S3568, A1129

S5328A (ACTIVE) - Summary

Relates 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.

S5328A (ACTIVE) - Sponsor Memo

S5328A (ACTIVE) - Bill Text download pdf


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

                                 5328--A

                       2019-2020 Regular Sessions

                            I N  S E N A T E

                             April 26, 2019
                               ___________

Introduced  by  Sen. BRESLIN -- read twice and ordered printed, and when
  printed to be committed 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
  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;
  (II)  THE ADDITIONAL OR RELATED 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 RELATED SERVICE OR PROCEDURE WAS EXPERIMENTAL
OR INVESTIGATIONAL PURSUANT TO SECTION FOUR THOUSAND NINE  HUNDRED  FOUR

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

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