Assembly Bill A9407

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   9407
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             December 19, 2025
                                ___________
 
 Introduced by M. of A. PAULIN -- read once and referred to the Committee
   on Insurance
 
 AN  ACT to amend the insurance law, the public health law and the social
   services law, in relation to not  requiring  prior  authorization  for
   certain cancer treatments
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Section 3217-b of the insurance law is amended by adding  a
 new subsection (p) to read as follows:
   (P)  NO INSURER SUBJECT TO THIS ARTICLE SHALL REQUIRE A PRIOR AUTHORI-
 ZATION DETERMINATION FOR CANCER TREATMENT MEETING CATEGORY ONE OR  CATE-
 GORY  TWO-A OF THE NATIONAL COMPREHENSIVE CANCER NETWORK'S CATEGORIES OF
 EVIDENCE AND CONSENSUS, PROVIDED THAT SUCH INSURER MAY REQUIRE A  HEALTH
 CARE  PROVIDER  TO CERTIFY THAT THE COURSE OF TREATMENT FOR THE ONCOLOGY
 PATIENT MEETS NATIONAL COMPREHENSIVE CANCER NETWORK GUIDELINES.  NOTHING
 IN THIS SUBSECTION SHALL PROHIBIT AN INSURER FROM DENYING  A  CLAIM  FOR
 SUCH  SERVICES IF THE SERVICES ARE SUBSEQUENTLY DETERMINED NOT MEDICALLY
 NECESSARY.
   § 2. Section 4325 of the insurance law is  amended  by  adding  a  new
 subsection (p) to read as follows:
   (P)  NO CORPORATION ORGANIZED UNDER THIS ARTICLE SHALL REQUIRE A PRIOR
 AUTHORIZATION DETERMINATION FOR CANCER TREATMENT MEETING CATEGORY ONE OR
 CATEGORY TWO-A OF THE NATIONAL COMPREHENSIVE CANCER NETWORK'S CATEGORIES
 OF EVIDENCE AND CONSENSUS, PROVIDED THAT SUCH CORPORATION MAY REQUIRE  A
 HEALTH  CARE  PROVIDER  TO  CERTIFY THAT THE COURSE OF TREATMENT FOR THE
 ONCOLOGY PATIENT MEETS NATIONAL COMPREHENSIVE CANCER NETWORK GUIDELINES.
 NOTHING IN THIS SUBSECTION SHALL PROHIBIT A CORPORATION FROM  DENYING  A
 CLAIM  FOR SUCH SERVICES IF THE SERVICES ARE SUBSEQUENTLY DETERMINED NOT
 MEDICALLY NECESSARY.
   § 3. Section 4406-c of the public health law is amended  by  adding  a
 new subdivision 14 to read as follows:
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD14275-01-5
              

 A. 9407                             2
 
   14.  NO  HEALTH CARE PLAN SHALL REQUIRE A PRIOR AUTHORIZATION DETERMI-
 NATION FOR CANCER TREATMENT MEETING CATEGORY ONE OR  CATEGORY  TWO-A  OF
 THE  NATIONAL  COMPREHENSIVE CANCER NETWORK'S CATEGORIES OF EVIDENCE AND
 CONSENSUS, PROVIDED THAT SUCH HEALTH CARE PLAN MAY REQUIRE A HEALTH CARE
 PROVIDER  TO  CERTIFY  THAT  THE  COURSE  OF  TREATMENT FOR THE ONCOLOGY
 PATIENT MEETS NATIONAL COMPREHENSIVE CANCER NETWORK GUIDELINES.  NOTHING
 IN  THIS  SUBDIVISION  SHALL  PROHIBIT A HEALTH CARE PLAN FROM DENYING A
 CLAIM FOR SUCH SERVICES IF THE SERVICES ARE SUBSEQUENTLY DETERMINED  NOT
 MEDICALLY NECESSARY.
   §  4.  Section 364-j of the social services law is amended by adding a
 new subdivision 26-d to read as follows:
   26-D. MANAGED CARE PROVIDERS SHALL NOT REQUIRE A  PRIOR  AUTHORIZATION
 DETERMINATION  FOR  CANCER  TREATMENT  MEETING  CATEGORY ONE OR CATEGORY
 TWO-A OF THE  NATIONAL  COMPREHENSIVE  CANCER  NETWORK'S  CATEGORIES  OF
 EVIDENCE  AND CONSENSUS, PROVIDED THAT THE MANAGED CARE PLAN MAY REQUIRE
 A HEALTH CARE PROVIDER TO CERTIFY THAT THE COURSE OF TREATMENT  FOR  THE
 ONCOLOGY PATIENT MEETS NATIONAL COMPREHENSIVE CANCER NETWORK GUIDELINES.
 NOTHING  IN  THIS  SUBDIVISION  SHALL  PROHIBIT A MANAGED CARE PLAN FROM
 DENYING A CLAIM FOR SUCH  SERVICES  IF  THE  SERVICES  ARE  SUBSEQUENTLY
 DETERMINED NOT MEDICALLY NECESSARY.
   § 5. This act shall take effect on the one hundred eightieth day after
 it  shall  have  become a law; provided, however, that the amendments to
 section 364-j of the social services law made by section  four  of  this
 act  shall  be  subject to the expiration and repeal of such section and
 shall expire and be deemed repealed therewith.