BILL NUMBER:S6459

TITLE OF BILL:  An act to amend the insurance law and the public health
law, in relation to shortening time frames during which an insurer has
to determine whether a pre-authorization request is medically necessary

PURPOSE:  To shorten time frames during which an insurer has to deter-
mine whether a pre-authorization request is medically necessary.

SUMMARY OF PROVISIONS:

Section 1. Amends Subsection (b) of section 4903 of the insurance law to
require that a utilization review agent shall make a determination
involving health care services which require pre-authorization and
provide notice of the determination to the insured by telephone and in
writing within three days, rather than three business days, of receipt
of the necessary information.

Section 2. Amends subdivision 2 of section 4903 of the public health law
to require that a utilization review agent shall make a utilization
review determination involving health care services which require pre-
authorization and provide notice of a determination to the enrollee by
telephone and in writing within three days of receipt of the necessary
information.

Section 3. Effective date.
              

JUSTIFICATION:  Hospitalized patients must receive pre-authorization
from their insurance companies in order to have some health care
services covered, including the transfer of a patient from a hospital to
a nursing home or rehabilitation center. Currently, the timeframe within
which insurance companies must issue this determination is three busi-
ness days. However, this time frame is too long for many patients,
particularly over long holiday weekends. During holiday weekends, the
patient must wait an additional three to four days in the hospital with-
out beginning to recover.

The current time frame prevents many patients from leaving the hospital
as they prepare to be transferred to a rehabilitation facility. These
rehabilitation facilities are often prepared to accept the patient, but
cannot do so without pre-authorization from the insurance company.

Many of these insurance companies already have customer service repre-
sentatives available during these days to answer questions from individ-
uals or to sign up individuals for coverage. This bill would shorten the
time frame within which approval is required so that hospitalized
patients can begin the healing process in a timely manner.

LEGISLATIVE HISTORY: New bill.

FISCAL IMPLICATIONS: None.

EFFECTIVE DATE:  This act shall take effect on the same date and in the
same manner as section 5 of chapter 514 of the laws of 2013, takes
effect.