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 |
Senate Bill S5328
Signed By Governor2019-2020 Legislative Session
Sponsored By
(D, WF) 46th Senate District
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
Actions
Votes
Bill Amendments
2019-S5328 - Details
2019-S5328 - Sponsor Memo
BILL NUMBER: S5328 SPONSOR: BRESLIN TITLE OF BILL: 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 PURPOSE: To expand the current prior authorization exception for surgical and invasive procedures to include concurrent symptoms and side effects. SUMMARY OF PROVISIONS: Section 1 of the bill adds a new subsection (c-1) of section 3238 of the Insurance Law to include concurrent symptoms and side effects to the types of conditions that cannot be denied for lack of prior authori- zation. Section two provides that this act shall take effect 90 days after enactment.
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
(D, WF) Senate District
2019-S5328A (ACTIVE) - Details
2019-S5328A (ACTIVE) - Sponsor Memo
BILL NUMBER: S5328A SPONSOR: BRESLIN TITLE OF BILL: 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 relating thereto PURPOSE: To expand the current prior authorization exception for surgical and invasive procedures to include concurrent symptoms and side effects. SUMMARY OF PROVISIONS: Section 1 of the bill adds a new subsection (c-1) of section 3238 of the Insurance Law to include concurrent symptoms and side effects to the types of conditions that cannot be denied for lack of prior authori- zation.
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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