Senate Bill S5328

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

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

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Bill Amendments

2019-S5328 - Details

Law Section:
Insurance Law
Laws Affected:
Amd §3238, Ins L
Versions Introduced in Other Legislative Sessions:
2015-2016: S7558
2017-2018: S3568

2019-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.

2019-S5328 - Sponsor Memo

2019-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

2019-S5328A (ACTIVE) - Details

Law Section:
Insurance Law
Laws Affected:
Amd §3238, Ins L
Versions Introduced in Other Legislative Sessions:
2015-2016: S7558
2017-2018: S3568

2019-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.

2019-S5328A (ACTIVE) - Sponsor Memo

2019-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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