assembly Bill A9908A

2021-2022 Legislative Session

Relates to exemptions from preauthorization requirements in certain circumstances

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Sponsored By

Current Bill Status - In Assembly Committee


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor

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Actions

view actions (3)
Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Apr 20, 2022 print number 9908a
Apr 20, 2022 amend (t) and recommit to insurance
Apr 19, 2022 referred to insurance

Co-Sponsors

A9908 - Details

See Senate Version of this Bill:
S8299
Current Committee:
Assembly Insurance
Law Section:
Insurance Law
Laws Affected:
Amd §4902, Ins L; amd §4902, Pub Health L

A9908 - Summary

Exempts health care professionals from preauthorization requirements where the insurer or health care plan has approved not less than ninety percent of such professional's preauthorization requests in the preceding six-month evaluation period.

A9908 - Bill Text download pdf

 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   9908
 
                           I N  A S S E M B L Y
 
                              April 19, 2022
                                ___________
 
 Introduced  by  M.  of A. McDONALD, WOERNER -- read once and referred to
   the Committee on Insurance
 
 AN ACT to amend the public health law, in relation  to  exemptions  from
   preauthorization requirements in certain circumstances
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section 1. Section 4902 of the public health law is amended by  adding
 a new subdivision 5 to read as follows:
   5.  (A)  A  HEALTH  CARE PLAN THAT USES A PREAUTHORIZATION PROCESS FOR
 HEALTH CARE SERVICES SHALL NOT REQUIRE A  HEALTH  CARE  PROFESSIONAL  TO
 OBTAIN  PREAUTHORIZATION FOR A PARTICULAR HEALTH CARE SERVICE IF, IN THE
 MOST RECENT SIX-MONTH EVALUATION  PERIOD,  SUCH  HEALTH  CARE  PLAN  HAS
 APPROVED  NOT  LESS THAN NINETY PERCENT OF THE PREAUTHORIZATION REQUESTS
 SUBMITTED BY SUCH HEALTHCARE PROFESSIONAL FOR THE PARTICULAR HEALTH CARE
 SERVICE.
   (B) A HEALTH CARE PLAN SHALL EVALUATE WHETHER A  HEALTH  CARE  PROFES-
 SIONAL  QUALIFIES  FOR  AN  EXEMPTION FROM PREAUTHORIZATION REQUIREMENTS
 UNDER PARAGRAPH (A) OF THIS SUBDIVISION ONCE EVERY SIX MONTHS.
   (C) A HEALTH CARE PLAN MAY CONTINUE AN EXEMPTION UNDER  PARAGRAPH  (A)
 OF  THIS  SUBDIVISION WITHOUT EVALUATING WHETHER THE HEALTH CARE PROFES-
 SIONAL QUALIFIES FOR THE EXEMPTION FOR A PARTICULAR EVALUATION PERIOD.
   (D) A HEALTH CARE PROFESSIONAL SHALL NOT BE  REQUIRED  TO  REQUEST  AN
 EXEMPTION TO QUALIFY FOR SUCH EXEMPTION.
   (E)  A  HEALTH  CARE  PROFESSIONAL'S  EXEMPTION  FROM PREAUTHORIZATION
 REQUIREMENTS UNDER PARAGRAPH (A) OF THIS  SUBDIVISION  SHALL  REMAIN  IN
 EFFECT UNTIL:
   (I)  THE THIRTIETH DAY AFTER THE HEALTH CARE PLAN NOTIFIES SUCH HEALTH
 CARE PROFESSIONAL OF SUCH HEALTH CARE PLAN'S  DETERMINATION  TO  RESCIND
 SUCH  EXEMPTION  IF  SUCH  HEALTH CARE PROFESSIONAL DOES NOT APPEAL SUCH
 HEALTH CARE PLAN'S DETERMINATION; OR
   (II) IF SUCH HEALTH CARE PROFESSIONAL APPEALS SUCH DETERMINATION,  THE
 FIFTH  DAY AFTER THE INDEPENDENT REVIEW ORGANIZATION AFFIRMS SUCH HEALTH
 CARE PLAN'S DETERMINATION TO RESCIND SUCH EXEMPTION. IF  A  HEALTH  CARE
 PLAN  DOES NOT FINALIZE A RESCISSION DETERMINATION, THEN THE HEALTH CARE
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

Co-Sponsors

view additional co-sponsors

Multi-Sponsors

A9908A (ACTIVE) - Details

See Senate Version of this Bill:
S8299
Current Committee:
Assembly Insurance
Law Section:
Insurance Law
Laws Affected:
Amd §4902, Ins L; amd §4902, Pub Health L

A9908A (ACTIVE) - Summary

Exempts health care professionals from preauthorization requirements where the insurer or health care plan has approved not less than ninety percent of such professional's preauthorization requests in the preceding six-month evaluation period.

A9908A (ACTIVE) - Bill Text download pdf

 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  9908--A
 
                           I N  A S S E M B L Y
 
                              April 19, 2022
                                ___________
 
 Introduced  by  M.  of A. McDONALD, WOERNER -- read once and referred 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 and the public health law, in relation
   to  exempting health care professionals from preauthorization require-
   ments in certain circumstances

   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Subsection  (a)  of  section 4902 of the insurance law is
 amended by  adding a new paragraph 14 to read as follows:
   (14) ESTABLISHMENT OF AN EXEMPTION FROM PREAUTHORIZATION  REQUIREMENTS
 FOR HEALTH CARE PROFESSIONALS PROVIDING HEALTH CARE SERVICES WHICH SHALL
 INCLUDE THAT:
   (I)  AN  INSURER  THAT USES A PREAUTHORIZATION PROCESS FOR HEALTH CARE
 SERVICES SHALL NOT REQUIRE A HEALTH CARE PROFESSIONAL TO  OBTAIN  PREAU-
 THORIZATION  FOR A PARTICULAR HEALTH CARE SERVICE IF, IN THE MOST RECENT
 SIX-MONTH EVALUATION PERIOD, THE INSURER  HAS  APPROVED  NOT  LESS  THAN
 NINETY PERCENT OF THE PREAUTHORIZATION REQUESTS SUBMITTED BY SUCH HEALTH
 CARE PROFESSIONAL FOR THE PARTICULAR HEALTH CARE SERVICE;
   (II)  THE  INSURER  SHALL  EVALUATE WHETHER A HEALTH CARE PROFESSIONAL
 QUALIFIES FOR AN  EXEMPTION  FROM  PREAUTHORIZATION  REQUIREMENTS  UNDER
 SUBPARAGRAPH (I) OF THIS PARAGRAPH ONCE EVERY SIX MONTHS;
   (III)  THE INSURER MAY CONTINUE AN EXEMPTION UNDER SUBPARAGRAPH (I) OF
 THIS PARAGRAPH WITHOUT EVALUATING WHETHER THE HEALTH  CARE  PROFESSIONAL
 QUALIFIES FOR THE EXEMPTION FOR A PARTICULAR EVALUATION PERIOD;
   (IV)  A  HEALTH  CARE PROFESSIONAL SHALL NOT BE REQUIRED TO REQUEST AN
 EXEMPTION TO QUALIFY FOR THE EXEMPTION;
   (V) A  HEALTH  CARE  PROFESSIONAL'S  EXEMPTION  FROM  PREAUTHORIZATION
 REQUIREMENTS  UNDER  SUBPARAGRAPH  (I) OF THIS PARAGRAPH SHALL REMAIN IN
 EFFECT UNTIL:
   (A) THE THIRTIETH DAY AFTER THE DATE THE INSURER NOTIFIES  THE  HEALTH
 CARE  PROFESSIONAL  OF  THE    INSURER'S  DETERMINATION  TO  RESCIND THE
 EXEMPTION PURSUANT TO SUBPARAGRAPH (VII) OF THIS PARAGRAPH IF THE HEALTH
 CARE PROFESSIONAL DOES NOT APPEAL SUCH DETERMINATION; OR
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.