Assembly Actions -
Lowercase Senate Actions - UPPERCASE |
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---|---|
Jan 04, 2012 |
referred to health |
Apr 08, 2011 |
referred to health |
Senate Bill S4509
2011-2012 Legislative Session
Sponsored By
(R, C, IP) Senate District
Archive: Last Bill Status - In Senate Committee Health 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
Actions
co-Sponsors
(D) Senate District
(R, C, IP) Senate District
(D, WF) 28th Senate District
(R, C) Senate District
2011-S4509 (ACTIVE) - Details
- See Assembly Version of this Bill:
- A659
- Current Committee:
- Senate Health
- Law Section:
- Public Health Law
- Laws Affected:
- Amd §§4902, 4903, 4904, 4905, & 4910, Pub Health L; amd §§4902, 4903, 4904, 4905 & 4910, Ins L
- Versions Introduced in Other Legislative Sessions:
-
2009-2010:
A792
2013-2014: A2691
2011-S4509 (ACTIVE) - Sponsor Memo
BILL NUMBER:S4509 TITLE OF BILL: An act to amend the public health law and the insurance law, in relation to approvals by a utilization review agent PURPOSE: To improve managed care market conduct and to prohibit inappropriate health insurance practices SUMMARY OF PROVISIONS: Sections 1 and 2 enhance the utilization review law; Sections 3 and 4 ensure payment for authorized medical care; Sections 5-10 protect providers' rights under the external appeals law; Sections 11 is the effective date. JUSTIFICATION: New York State law establishes timeframes in which utilization review agents must make adverse determinations. However, the law needs to be enhanced to protect consumers and providers. The way the current statute is written, the failure of a health plan to
2011-S4509 (ACTIVE) - Bill Text download pdf
S T A T E O F N E W Y O R K ________________________________________________________________________ 4509 2011-2012 Regular Sessions I N S E N A T E April 8, 2011 ___________ Introduced by Sen. HANNON -- read twice and ordered printed, and when printed to be committed to the Committee on Health AN ACT to amend the public health law and the insurance law, in relation to approvals by a utilization review agent THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Paragraph (h) of subdivision 1 of section 4902 of the public health law, as added by chapter 705 of the laws of 1996, is amended to read as follows: (h) Establishment of a requirement that emergency services rendered to an enrollee shall not be subject to prior authorization nor shall reimbursement for such services be denied on retrospective review; provided, however, that such services are medically necessary to stabi- lize or treat an emergency condition. IN REVIEWING A DENIAL FOR COVER- AGE OF EMERGENCY SERVICES TO TREAT AN EMERGENCY MEDICAL CONDITION, THE UTILIZATION REVIEW AGENT SHALL TAKE THE FOLLOWING FACTORS INTO CONSIDER- ATION: (1) THE TIME OF DAY AND DAY OF THE WEEK THE CARE WAS PROVIDED; (2) THE PRESENTING SYMPTOMS, INCLUDING BUT NOT LIMITED TO, SEVERE PAIN, TO ENSURE THAT THE DECISION TO DENY REIMBURSEMENT FOR EMERGENCY SERVICE IS NOT MADE SOLELY ON THE BASIS OF THE FINAL DIAGNOSIS. S 2. Subdivision 7 of section 4903 of the public health law, as added by chapter 586 of the laws of 1998, is amended to read as follows: 7. Failure by the utilization review agent to make a determination within the time periods prescribed in this section shall be deemed to be an [adverse determination subject to appeal pursuant to section forty nine hundred four of this title] APPROVAL. S 3. Subdivision 1 of section 4904 of the public health law, as added by chapter 705 of the laws of 1996, is amended to read as follows: 1. An enrollee, the enrollee's designee and[, in connection with retrospective adverse determinations,] an enrollee's health care provid- EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD02281-02-1
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