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Assembly Bill A10679

2023-2024 Legislative Session

Establishes a mandated window of five business days for both Medicaid and private insurers to respond to pre-authorization claims for testing and/or treatments made by physicians on behalf of oncology patients

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Archive: Last Bill Status - In Assembly Committee

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2023-A10679 (ACTIVE) - Details

See Senate Version of this Bill:
S9858
Current Committee:
Assembly Insurance
Law Section:
Insurance Law
Laws Affected:
Amd §3238, Ins L
Versions Introduced in 2025-2026 Legislative Session:
A1462, S586

2023-A10679 (ACTIVE) - Summary

Establishes a mandated window of five business days for both Medicaid and private insurers to respond to pre-authorization claims for testing and/or treatments made by physicians on behalf of oncology patients.

2023-A10679 (ACTIVE) - Bill Text download pdf 

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   10679
 
                           I N  A S S E M B L Y
 
                              August 28, 2024
                                ___________
 
 Introduced  by  COMMITTEE ON RULES -- (at request of M. of A. Hunter) --
   read once and referred to the Committee on Insurance
 
 AN ACT to amend  the  insurance  law,  in  relation  to  establishing  a
   mandated  window  of  five business days for both Medicaid and private
   insurers to respond to pre-authorization  claims  for  testing  and/or
   treatments made by physicians on behalf of oncology patients

   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subsection (a) of section 3238  of  the  insurance  law  is
 amended by adding a new paragraph 7 to read as follows:
   (7)  WITH  REGARD  TO CLAIMS OF PRE-AUTHORIZATION FILED BY A PHYSICIAN
 WITH PRIVATE INSURERS AND/OR MEDICAID ON BEHALF OF AN ONCOLOGY  PATIENT,
 IT  IS  HEREBY  MANDATED  THAT A WAITING PERIOD OF FIVE BUSINESS DAYS BE
 ESTABLISHED IN WHICH AN INSURER MUST RESPOND TO SUCH A CLAIM. IF IN SUCH
 A CASE THE INSURER DOES NOT RENDER A DECISION AND NOTIFY  THE  PHYSICIAN
 WITHIN  THE  PERIOD OF FIVE BUSINESS DAYS FOLLOWING THE FILING OF A PRE-
 AUTHORIZATION CLAIM, THE PHYSICIAN DEEMED RESPONSIBLE FOR  TREATING  THE
 PATIENT  IS  AUTHORIZED TO CONDUCT THE LIFESAVING TESTING, TREATMENT, OR
 PROCEDURE AND AS SUCH, THE INSURER  WILL  BE  MADE  LIABLE  FOR  PAYMENT
 COVERING THE PRESCRIBED METHOD OF CARE.
   § 2. This act shall take effect immediately.
 
 
 
 
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD15856-01-4

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