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

                                  9051

                          I N  A S S E M B L Y

                            January 20, 2016
                               ___________

Introduced by M. of A. JOYNER -- 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  REQUIRING 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
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-

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

                                                           LBD00626-01-5

A. 9051                             2

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.