S T A T E   O F   N E W   Y O R K
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                                  3520

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                            January 28, 2013
                               ___________

Introduced  by M. of A. ROZIC -- read once and referred to the Committee
  on Insurance

AN ACT to amend the insurance law and the public health law, in relation
  to enacting the "health insurance preauthorization disclosure act"

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1.  Short  title. This act shall be known and may be cited as
the "health insurance preauthorization disclosure act".
  S 2. The insurance law is amended by adding a new section 4242 to read
as follows:
  S 4242. HEALTH INSURANCE COMPANIES; PREAUTHORIZATION FOR  HEALTH  CARE
SERVICES.  EVERY  HEALTH  CARE  INSURANCE  COMPANY  SHALL BE REQUIRED TO
PROVIDE PARTICIPATING PHYSICIANS AND HEALTH CARE PROVIDERS,  AS  DEFINED
IN SUBDIVISION SEVEN OF SECTION TWENTY-NINE HUNDRED EIGHTY OF THE PUBLIC
HEALTH LAW, WITH AN UPDATED  LIST OF HEALTH CARE TREATMENTS AND SERVICES
THAT  REQUIRE PREAUTHORIZATION OR PRECERTIFICATION FROM SUCH HEALTH CARE
INSURANCE COMPANY.  SUCH LIST SHALL BE DEVELOPED BASED UPON CONSULTATION
WITH MEDICAL GUIDELINES DEVELOPED  BY  THE  RELEVANT  MEDICAL  SPECIALTY
ORGANIZATION  AND  IN CONSULTATION WITH APPROPRIATELY TRAINED PHYSICIANS
PRACTICING WITHIN THE REGION THE HEALTH CARE INSURANCE  COMPANY  SERVES.
SUCH  LIST  SHALL BE UPDATED ANNUALLY OR MORE FREQUENTLY AS APPROPRIATE.
ONLY THOSE HEALTH CARE SERVICES WHICH ARE CONTAINED ON SUCH  LIST  SHALL
BE  SUBJECT  TO PRE-AUTHORIZATION OR PRECERTIFICATION BY THE HEALTH CARE
INSURANCE COMPANY. NO HEALTH CARE TREATMENT OR SERVICE SHALL BE ADDED TO
THE LIST OF  SERVICES  REQUIRED  PRE-AUTHORIZATION  OR  PRECERTIFICATION
UNLESS  THE  HEALTH  CARE INSURANCE COMPANY PROVIDES A MINIMUM OF NINETY
DAYS NOTICE TO PARTICIPATING PHYSICIANS AND HEALTH CARE PROVIDERS.
  S 3. The public health law is amended by adding a new  section  4905-a
to read as follows:
  S  4905-A.  PRE-AUTHORIZED  SERVICES.  EVERY HEALTH CARE PLAN SHALL BE
REQUIRED TO DEVELOP AND PROVIDE TO PARTICIPATING HEALTH CARE PROVIDERS A

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD05054-01-3
              

A. 3520                             2

LIST OF HEALTH CARE SERVICES THAT REQUIRE PRE-AUTHORIZATION  OR  PRECER-
TIFICATION  FROM  SUCH  HEALTH  CARE  PLAN. SUCH LIST SHALL BE DEVELOPED
BASED UPON CONSULTATION WITH MEDICAL GUIDELINES DEVELOPED BY  THE  RELE-
VANT  MEDICAL  SPECIALTY ORGANIZATION AND IN CONSULTATION WITH APPROPRI-
ATELY TRAINED PHYSICIANS PRACTICING WITHIN THE REGION  THE  HEALTH  CARE
PLAN  SERVES.  SUCH LIST SHALL BE UPDATED ANNUALLY OR MORE FREQUENTLY AS
APPROPRIATE. ONLY THOSE HEALTH CARE SERVICES WHICH ARE CONTAINED ON SUCH
LIST SHALL BE SUBJECT TO PRE-AUTHORIZATION OR  PRECERTIFICATION  BY  THE
HEALTH  CARE PLAN.  NO HEALTH CARE SERVICE SHALL BE ADDED TO THE LIST OF
SERVICES REQUIRING  PRE-AUTHORIZATION  OR  PRECERTIFICATION  UNLESS  THE
HEALTH CARE PLAN PROVIDES A MINIMUM OF NINETY DAYS NOTICE TO PARTICIPAT-
ING HEALTH CARE PROVIDERS.
  S  4.  The  insurance law is amended by adding a new section 4905-a to
read as follows:
  S 4905-A. PRE-AUTHORIZED SERVICES. EVERY HEALTH  CARE  PLAN  SHALL  BE
REQUIRED TO DEVELOP AND PROVIDE TO PARTICIPATING HEALTH CARE PROVIDERS A
LIST  OF  HEALTH CARE SERVICES THAT REQUIRE PRE-AUTHORIZATION OR PRECER-
TIFICATION FROM SUCH HEALTH CARE PLAN.  SUCH  LIST  SHALL  BE  DEVELOPED
BASED  UPON  CONSULTATION WITH MEDICAL GUIDELINES DEVELOPED BY THE RELE-
VANT MEDICAL SPECIALTY ORGANIZATION AND IN CONSULTATION  WITH  APPROPRI-
ATELY  TRAINED  PHYSICIANS  PRACTICING WITHIN THE REGION THE HEALTH CARE
PLAN SERVES. SUCH LIST SHALL BE UPDATED ANNUALLY OR MORE  FREQUENTLY  AS
APPROPRIATE. ONLY THOSE HEALTH CARE SERVICES WHICH ARE CONTAINED ON SUCH
LIST  SHALL  BE  SUBJECT TO PRE-AUTHORIZATION OR PRECERTIFICATION BY THE
HEALTH CARE PLAN.  NO HEALTH CARE SERVICE SHALL BE ADDED TO THE LIST  OF
SERVICES  REQUIRING  PRE-AUTHORIZATION  OR  PRECERTIFICATION  UNLESS THE
HEALTH CARE PLAN PROVIDES A MINIMUM OF NINETY DAYS NOTICE TO PARTICIPAT-
ING HEALTH CARE PROVIDERS.
  S 5. This act shall take effect on the sixtieth  day  after  it  shall
have  become  a law; provided, however that the superintendent of finan-
cial services is hereby authorized to promulgate  all  rules  and  regu-
lations  and  take any other measures necessary to implement this act on
its effective date.