Senate Bill S10232

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   10232
 
                             I N  S E N A T E
 
                                May 7, 2026
                                ___________
 
 Introduced  by Sen. HARCKHAM -- read twice and ordered printed, and when
   printed to be committed 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:
   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
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD14275-01-5
 S. 10232                            2
 
 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.