Assembly Bill A859

2023-2024 Legislative Session

Requires insurers and health plans to grant automatic preauthorization approvals to eligible health care professionals in certain circumstance

download bill text pdf

Sponsored By

Current Bill Status - In Assembly Committee


  • 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

co-Sponsors

multi-Sponsors

2023-A859 - Details

Current Committee:
Assembly Insurance
Law Section:
Insurance Law
Laws Affected:
Amd §4902, Ins L; amd §4902, Pub Health L
Versions Introduced in 2021-2022 Legislative Session:
A9908

2023-A859 - Summary

Requires insurers and health plans to grant automatic preauthorization approvals to eligible health care professionals in certain circumstances.

2023-A859 - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                    859
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 11, 2023
                                ___________
 
 Introduced  by M. of A. McDONALD, WOERNER, STECK, SEAWRIGHT, SILLITTI --
   read once and referred to the Committee on Insurance
 
 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
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD02507-01-3
              

co-Sponsors

multi-Sponsors

2023-A859A (ACTIVE) - Details

Current Committee:
Assembly Insurance
Law Section:
Insurance Law
Laws Affected:
Amd §4902, Ins L; amd §4902, Pub Health L
Versions Introduced in 2021-2022 Legislative Session:
A9908

2023-A859A (ACTIVE) - Summary

Requires insurers and health plans to grant automatic preauthorization approvals to eligible health care professionals in certain circumstances.

2023-A859A (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  859--A
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 11, 2023
                                ___________
 
 Introduced  by  M.  of A. McDONALD, WOERNER, STECK, SEAWRIGHT, SILLITTI,
   GUNTHER, STIRPE,  CUNNINGHAM,  RIVERA,  KELLES,  ALVAREZ,  LUPARDO  --
   Multi-Sponsored by -- M.  of A. SIMON -- read once and referred to the
   Committee on Insurance -- recommitted to the Committee on Insurance in
   accordance  with Assembly Rule 3, sec. 2 -- committee discharged, bill
   amended, ordered reprinted as amended and recommitted to said  commit-
   tee
 
 AN ACT to amend the insurance law and the public health law, in relation
   to  requiring insurers and health plans to grant automatic preauthori-
   zation approvals to eligible  health  care  professionals  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 15 to read as follows:
   (15) ESTABLISHMENT OF AUTOMATIC PREAUTHORIZATION APPROVAL REQUIREMENTS
 FOR  INSURERS  TO  PROVIDE TO HEALTH CARE PROFESSIONALS PROVIDING HEALTH
 CARE SERVICES WHICH SHALL INCLUDE THAT:
   (I) AN INSURER THAT USES A PREAUTHORIZATION PROCESS  FOR  HEALTH  CARE
 SERVICES  SHALL  PROVIDE  AN  AUTOMATIC  PREAUTHORIZATION  APPROVAL TO A
 HEALTH CARE PROFESSIONAL  FOR  A  PARTICULAR  HEALTH  CARE  SERVICE,  AS
 DEFINED UNDER THIS TITLE INCLUDING BUT NOT LIMITED TO HEALTH CARE PROCE-
 DURES,  TREATMENTS, SERVICES, PHARMACEUTICAL PRODUCTS, SERVICES OR DURA-
 BLE MEDICAL EQUIPMENT IF, IN THE MOST RECENT SIX-MONTH EVALUATION  PERI-
 OD,  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. FOR THE PURPOSES  OF  THIS  REQUIRE-
 MENT,  A PREAUTHORIZATION REQUEST SUBMITTED DURING THE EVALUATION PERIOD
 SHALL BE CONSIDERED AND COUNTED AS A SINGLE REQUEST AND SINGLE  APPROVAL
 IF  THE  REQUEST  WAS APPROVED AT ANY POINT BETWEEN THE DATE THE REQUEST
 WAS SUBMITTED BY THE HEALTH CARE PROFESSIONAL  AND  THE  FINAL  DETERMI-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD02507-06-4
              

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