BILL NUMBER: S7696

SPONSOR: CARLUCCI
 
TITLE OF BILL:

An act to amend the social services law, in relation to prohibiting
prior authorization for medically necessary and warranted ultrasounds

 
PURPOSE OR GENERAL IDEA OF THE BILL:

To prohibit managed care providers from requiring prior authorization
for any ultrasound that a physician deems to be medically necessary and
warranted

 
SUMMARY OF SPECIFIC PROVISIONS:

Section one of the bill amends the social services law by adding a new
subdivision 26-c prohibiting managed care providers from requiring prior
authorization for any ultrasound, which, in a physician's reasonable
professional judgment, are medically necessary and warranted.

              

Section two of the bill sets the effective date.

 
JUSTIFICATION:

Under current law, managed care providers can require health care
providers to obtain prior authorizations for ultrasound testing. This
requires the health care provider to contact the insurer and confirm
coverage for a standard, medically necessary procedure.

This recurrent obligation is extremely time-consuming and costly for
health care providers, particularly those with limited staff and
resources. As a result, some health care providers are unable to accept
patients with insurance that requires prior authorizations for routine
procedures.

Further, prior authorization requirements result in delays in ultrasound
testing, which can have serious consequences for patients.  Even in
life-threatening scenarios, patients may be reluctant to undergo any
testing that has not been preapproved, in fear of costly medical bills.

This legislation will prevent managed care providers from requiring
prior authorization for ultrasound testing. In turn, this legislation
will alleviate the burden on health care providers, will ensure that
patients are covered for medically necessary procedures, and will allow
for the timely administration of ultrasound tests.

 
LEGISLATIVE HISTORY:

New Legislation.

 
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:

None.

 
EFFECTIVE DATE:
This act shall take effect immediately.