NY State Senate Bill 2021-S8299

Senate Bill S8299

2021-2022 Legislative Session

Exempts health care professionals from preauthorization requirements in certain circumstances

download bill text pdf

Archive: Last Bill Status - In Senate Committee Rules 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

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Actions

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jun 03, 2022	committed to rules
Apr 27, 2022	advanced to third reading
Apr 26, 2022	2nd report cal.
Apr 25, 2022	1st report cal.768
Feb 10, 2022	referred to insurance

Votes

- Apr 25, 2022 - Insurance Committee Vote
  S8299
  
  10
  
  Aye
  
  0
  
  Nay
  
  1
  
  Aye with Reservations
  
  0
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  - - Insurance Committee Vote: Apr 25, 2022
      
      aye (10)
      
      Breslin
      
      Brooks
      
      Cooney
      
      Gounardes
      
      Harckham
      
      Kennedy
      
      O'Mara
      
      Parker
      
      Sanders Jr.
      
      Serino
      
      aye wr (1)
      
      Helming

co-Sponsors

2021-S8299 (ACTIVE) - Details

See Assembly Version of this Bill:: A9908
Current Committee:: Senate Rules
Law Section:: Insurance Law
Laws Affected:: Amd §4902, Ins L; amd §4902, Pub Health L
Versions Introduced in Other Legislative Sessions:: 2023-2024: S2680, A859
2025-2026: A2352

2021-S8299 (ACTIVE) - Summary

Exempts health care professionals from preauthorization requirements where the insurer or health care plan has approved not less than ninety percent of such professional's preauthorization requests in the preceding six-month evaluation period.

2021-S8299 (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S8299

SPONSOR: BRESLIN
 
TITLE OF BILL:

An act to amend the insurance law and the public health law, in relation
to exempting health care professionals from preauthorization require-
ments in certain circumstances

 
PURPOSE:

To establish an exemption from preauthorization requirements for health
care professionals when their requests are regularly approved by health
insurers.

 
SUMMARY OF PROVISIONS:

Amends Subsection (a) of section 4902 of the insurance law by adding a
new paragraph 14 to establish an exemption from preauthorization
requirements for health care professionals for a particular health care
service if in the most recent 6-month evaluation period, the insurer has
approved not less than 90% of the preauthorization requests submitted by

the health care professional for the particular health care service.
Additionally:

*The insurer shall evaluate whether a health care professional qualifies
for an exemption from preauthorization requirements once every 6 months.

*The insurer may continue an exemption without evaluating whether the
health care qualifies for the exemption for a particular evaluation
period.

*A health care professional shall not be required to request an
exemption to qualify for the exemption.

*A health care professional's exemption from preauthorization require-
ments shall remain in effect until:

*The 30th day after the date the insurer notifies the health care
professional of the insurer's determination to rescind the exemption
pursuant to subparagraph (vii) of this paragraph if the health care
professional does not appeal such determination.

*The health care professional appeals the determination, and an inde-
pendent review organization affirms the insurer's determination to
rescind the exemption, the fifth day after the affirmation of such
determination.

*Where an insurer does not finalize a rescission determination as speci-
fied in subparagraph (vii) of this paragraph, the health care profes-
sional shall be considered to have met the criteria to continue to qual-
ify for the exemption and such exemption shall remain in effect until
the following evaluation period.

*An insurer may rescind an exemption from preauthorization requirements:

*During January or June of each year the insurer makes a determination,
based upon a retrospective review of a random sample of no less than 5
but no more than 20 claims submitted by the health care professional
during the most recent evaluation period, that less than 90% percent of
the claims for the particular health care service met the medical neces-
sity criteria that would have been used by the insurer when conducting
preauthorization review for the particular health care service.

 *The insurer notifies the health care professional not less than 20
days before the proposed rescission is to take effect together with the
sample of claims used to make the determination and a plain language
explanation of the health care professional's right to appeal such
determination and instructions on how to initiate such appeal.

Section 2 would make corresponding changes to amends Subsection (a) of
section 4902 of the public health law.

Section 3 is the effective date.

 
JUSTIFICATION:

Many studies have detailed the growing hassles faced by health care
providers in their efforts to provide care to their patients. One such
hassle relates to prior authorization (PA) requirements, which is a
health plan cost utilization-management process that requires physicians
to get approval before a prescribed treatment, test, or medical service
can be provided to a patient. While this management tool can certainly
be appropriate in some cases, it is often imposed beyond what is neces-
sary. A survey released in December 2020, by the American Medical Asso-
ciation (AMA) detailed the consequences of excessive PA requirements,
reporting that the vast majority (91%) of respondents said PA resulted
in notable delays in care. Moreover, 87% reported that prior authori-
zation interferes with continuity of care, while 83% reported that the
number of prior authorizations required has increased over the past five
years. Adding to these concerns is that many health care services
requiring a PA are overwhelmingly approved by a health plan, yet still
are required, which imposes excessive amounts of unnecessary administra-
tive burdens on health care professionals that take time away from
delivering patient care and exacerbates the concerning tren d of "burn-
out" among various health care professionals.

In response to these hassles, last year the Texas Legislature enacted a
law, also known as a "Gold Card" program, under which a payer exempts
physicians from otherwise applicable PA requirements when they regularly
receive pre-authorization for a particular health care service. This
legislation would follow the same model, where a health care provider
who receives pre-approval for a procedure at least 90% of the time, is
exempted for the next 6 months from having to receive pre-approval. At
the conclusion of the period, the health plan has the opportunity to
rescind the exemption going forward based upon a retroactive review of
claim submissions. The process has been compared to the Transportation
Security Administration's (TSA) PreCheck program, which allows frequent
airline travelers to get expedited security screening.

 
LEGISLATIVE HISTORY:

New bill.

 
FISCAL IMPLICATIONS:

None to the stat
 
EFFECTIVE DATE:
This act shall take effect on the one hundred eightieth day after it
shall become a law.

2021-S8299 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   8299
 
                             I N  S E N A T E
 
                             February 10, 2022
                                ___________
 
 Introduced  by  Sen. BRESLIN -- read twice and ordered printed, and when
   printed to be committed to the Committee on Insurance
 
 AN ACT to amend the insurance law and the public health law, in relation
   to exempting health care professionals from preauthorization  require-
   ments in certain circumstances
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subsection (a) of section 4902  of  the  insurance  law  is
 amended by  adding a new paragraph 14 to read as follows:
   (14)  ESTABLISHMENT OF AN EXEMPTION FROM PREAUTHORIZATION REQUIREMENTS
 FOR HEALTH CARE PROFESSIONALS PROVIDING HEALTH CARE SERVICES WHICH SHALL
 INCLUDE THAT:
   (I) AN INSURER THAT USES A PREAUTHORIZATION PROCESS  FOR  HEALTH  CARE
 SERVICES  SHALL  NOT REQUIRE A HEALTH CARE PROFESSIONAL TO OBTAIN PREAU-
 THORIZATION FOR A PARTICULAR HEALTH CARE SERVICE IF, IN THE MOST  RECENT
 SIX-MONTH  EVALUATION  PERIOD,  THE  INSURER  HAS APPROVED NOT LESS THAN
 NINETY PERCENT OF THE PREAUTHORIZATION REQUESTS SUBMITTED BY SUCH HEALTH
 CARE PROFESSIONAL FOR THE PARTICULAR HEALTH CARE SERVICE;
   (II) THE INSURER SHALL EVALUATE WHETHER  A  HEALTH  CARE  PROFESSIONAL
 QUALIFIES  FOR  AN  EXEMPTION  FROM  PREAUTHORIZATION REQUIREMENTS UNDER
 SUBPARAGRAPH (I) OF THIS PARAGRAPH ONCE EVERY SIX MONTHS;
   (III) THE INSURER MAY CONTINUE AN EXEMPTION UNDER SUBPARAGRAPH (I)  OF
 THIS  PARAGRAPH  WITHOUT EVALUATING WHETHER THE HEALTH CARE PROFESSIONAL
 QUALIFIES FOR THE EXEMPTION FOR A PARTICULAR EVALUATION PERIOD;
   (IV) A HEALTH CARE PROFESSIONAL SHALL NOT BE REQUIRED  TO  REQUEST  AN
 EXEMPTION TO QUALIFY FOR THE EXEMPTION;
   (V)  A  HEALTH  CARE  PROFESSIONAL'S  EXEMPTION  FROM PREAUTHORIZATION
 REQUIREMENTS UNDER SUBPARAGRAPH (I) OF THIS PARAGRAPH  SHALL  REMAIN  IN
 EFFECT UNTIL:
   (A)  THE  THIRTIETH DAY AFTER THE DATE THE INSURER NOTIFIES THE HEALTH
 CARE PROFESSIONAL  OF  THE    INSURER'S  DETERMINATION  TO  RESCIND  THE
 EXEMPTION PURSUANT TO SUBPARAGRAPH (VII) OF THIS PARAGRAPH IF THE HEALTH
 CARE PROFESSIONAL DOES NOT APPEAL SUCH DETERMINATION; OR
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD14525-01-2

 S. 8299                             2
 
   (B)  WHERE  THE HEALTH CARE PROFESSIONAL APPEALS THE DETERMINATION AND
 THE INDEPENDENT REVIEW ORGANIZATION AFFIRMS THE INSURER'S  DETERMINATION
 TO  RESCIND  THE  EXEMPTION, THE FIFTH DAY AFTER THE AFFIRMATION OF SUCH
 DETERMINATION;
   (VI)  WHERE AN INSURER DOES NOT FINALIZE A RESCISSION DETERMINATION AS
 SPECIFIED IN SUBPARAGRAPH (VII)  OF  THIS  PARAGRAPH,  THE  HEALTH  CARE
 PROFESSIONAL SHALL BE CONSIDERED TO HAVE MET THE CRITERIA TO CONTINUE TO
 QUALIFY  FOR  THE  EXEMPTION  AND  SUCH EXEMPTION SHALL REMAIN IN EFFECT
 UNTIL THE FOLLOWING EVALUATION PERIOD;
   (VII) AN  INSURER  MAY  RESCIND  AN  EXEMPTION  FROM  PREAUTHORIZATION
 REQUIREMENTS UNDER SUBPARAGRAPH (I) OF THIS PARAGRAPH ONLY:
   (A) DURING JANUARY OR JUNE OF EACH YEAR; AND
   (B) THE INSURER MAKES A DETERMINATION, ON THE BASIS OF A RETROSPECTIVE
 REVIEW OF A RANDOM SAMPLE OF NOT FEWER THAN FIVE AND NO MORE THAN TWENTY
 CLAIMS  SUBMITTED BY THE HEALTH CARE PROFESSIONAL DURING THE MOST RECENT
 EVALUATION PERIOD THAT LESS THAN NINETY PERCENT OF THE  CLAIMS  FOR  THE
 PARTICULAR  HEALTH  CARE SERVICE MET THE MEDICAL NECESSITY CRITERIA THAT
 WOULD HAVE BEEN USED BY THE   INSURER WHEN  CONDUCTING  PREAUTHORIZATION
 REVIEW FOR THE PARTICULAR HEALTH CARE SERVICE DURING THE RELEVANT EVALU-
 ATION PERIOD; AND
   (C)  THE  INSURER  COMPLIES  WITH ALL OTHER APPLICABLE REQUIREMENTS OF
 THIS PARAGRAPH AND THE INSURER NOTIFIES THE HEALTH CARE PROFESSIONAL NOT
 LESS THAN TWENTY DAYS BEFORE THE PROPOSED RESCISSION IS TO TAKE  EFFECT,
 TOGETHER WITH THE SAMPLE OF CLAIMS USED TO MAKE THE DETERMINATION PURSU-
 ANT  TO CLAUSE (B) OF THIS SUBPARAGRAPH AND A PLAIN LANGUAGE EXPLANATION
 OF THE HEALTH CARE PROFESSIONAL'S RIGHT TO APPEAL SUCH DETERMINATION AND
 INSTRUCTIONS ON HOW TO INITIATE SUCH APPEAL;
   (VIII) NOTWITHSTANDING ANY CONTRARY PROVISION OF SUBPARAGRAPH  (I)  OF
 THIS  PARAGRAPH,  AN INSURER MAY DENY AN EXEMPTION FROM PREAUTHORIZATION
 REQUIREMENTS:
   (A) IF THE HEALTH CARE PROFESSIONAL DOES NOT HAVE THE EXEMPTION AT THE
 TIME OF THE RELEVANT EVALUATION PERIOD; AND
   (B) THE INSURER PROVIDES THE  HEALTH  CARE  PROFESSIONAL  WITH  ACTUAL
 STATISTICS AND DATA FOR THE RELEVANT PREAUTHORIZATION REQUEST EVALUATION
 PERIOD  AND  DETAILED  INFORMATION  SUFFICIENT  TO  DEMONSTRATE THAT THE
 HEALTH CARE PROFESSIONAL DOES NOT MEET THE  CRITERIA  FOR  AN  EXEMPTION
 PURSUANT TO SUBPARAGRAPH (I) OF THIS PARAGRAPH FOR THE PARTICULAR HEALTH
 CARE SERVICE;
   (IX) AFTER A FINAL DETERMINATION OR REVIEW AFFIRMING THE RESCISSION OR
 DENIAL  OF  AN  EXEMPTION  FOR A SPECIFIC HEALTH CARE SERVICE UNDER THIS
 PARAGRAPH, A HEALTH CARE PROFESSIONAL SHALL BE  ELIGIBLE  FOR  CONSIDER-
 ATION  OF AN EXEMPTION FOR THE SAME HEALTH CARE SERVICE AFTER THE EVALU-
 ATION PERIOD FOLLOWING THE EVALUATION PERIOD WHICH FORMED THE  BASIS  OF
 THE RESCISSION OR DENIAL OF AN EXEMPTION;
   (X)  THE  INSURER SHALL, NOT LATER THAN FIVE DAYS AFTER QUALIFYING FOR
 AN EXEMPTION PURSUANT TO SUBPARAGRAPH (I) OF THIS PARAGRAPH, PROVIDE  TO
 A HEALTH CARE PROFESSIONAL A NOTICE THAT SHALL INCLUDE:
   (A)  A  STATEMENT  THAT  THE HEALTH CARE PROFESSIONAL QUALIFIES FOR AN
 EXEMPTION PURSUANT TO THIS PARAGRAPH;
   (B) A DESCRIPTION OF THE HEALTH CARE SERVICES TO WHICH SUCH  EXEMPTION
 APPLIES; AND
   (C)  A  STATEMENT  OF THE DURATION THAT SUCH EXEMPTION SHALL REMAIN IN
 EFFECT; AND
   (XI) IN THE EVENT THAT THE HEALTH CARE PROFESSIONAL SUBMITS  A  PREAU-
 THORIZATION  REQUEST FOR A HEALTH CARE SERVICE FOR WHICH THE HEALTH CARE
 PROFESSIONAL QUALIFIES FOR AN EXEMPTION FROM  PREAUTHORIZATION  REQUIRE-
 S. 8299                             3
 
 MENTS  UNDER  SUBPARAGRAPH  (I)  OF  THIS PARAGRAPH,   THE INSURER SHALL
 PROMPTLY NOTIFY SUCH HEALTH CARE  PROFESSIONAL  THAT  SUCH  HEALTH  CARE
 PROFESSIONAL HAS QUALIFIED FOR AN EXEMPTION FOR SUCH HEALTH CARE SERVICE
 IN  ACCORDANCE  WITH  THE REQUIREMENTS OF SUBPARAGRAPH (X) OF THIS PARA-
 GRAPH.
   (XII) NOTHING IN THIS PARAGRAPH MAY BE CONSTRUED TO: (A)  AUTHORIZE  A
 HEALTH  CARE  PROFESSIONAL  TO PROVIDE A HEALTH CARE SERVICE OUTSIDE THE
 SCOPE OF SUCH HEALTH CARE  PROFESSIONAL'S  APPLICABLE  LICENSE;  OR  (B)
 PROHIBIT  A HEALTH INSURER FROM PERFORMING A RETROSPECTIVE REVIEW OF THE
 HEALTH CARE SERVICE PURSUANT TO SECTION FORTY-NINE HUNDRED THREE OF THIS
 TITLE.
   § 2. Subdivision 1 of section 4902 of the public health law is amended
 by adding a new paragraph (l) to read as follows:
   (L) ESTABLISHMENT OF AN EXEMPTION FROM  PREAUTHORIZATION  REQUIREMENTS
 FOR  HEALTH  CARE  PROFESSIONALS  PROVIDING CERTAIN HEALTH CARE SERVICES
 WHICH SHALL INCLUDE THAT:
   (I) A HEALTH CARE PLAN THAT USES A PREAUTHORIZATION PROCESS FOR HEALTH
 CARE SERVICES SHALL NOT REQUIRE A HEALTH  CARE  PROFESSIONAL  TO  OBTAIN
 PREAUTHORIZATION  FOR  A  PARTICULAR HEALTH CARE SERVICE IF, IN THE MOST
 RECENT SIX-MONTH EVALUATION PERIOD, THE HEALTH CARE  PLAN  HAS  APPROVED
 NOT  LESS THAN NINETY PERCENT OF THE PREAUTHORIZATION REQUESTS SUBMITTED
 BY SUCH HEALTH CARE PROFESSIONAL FOR THE PARTICULAR HEALTH CARE SERVICE;
   (II) SUCH HEALTH CARE  PLAN  SHALL  EVALUATE  WHETHER  A  HEALTH  CARE
 PROFESSIONAL  QUALIFIES  FOR AN EXEMPTION FROM PREAUTHORIZATION REQUIRE-
 MENTS UNDER SUBPARAGRAPH (I) OF THIS PARAGRAPH ONCE EVERY SIX MONTHS;
   (III) THE HEALTH CARE PLAN MAY CONTINUE AN  EXEMPTION  UNDER  SUBPARA-
 GRAPH  (I)  OF THIS PARAGRAPH WITHOUT EVALUATING WHETHER THE HEALTH CARE
 PROFESSIONAL QUALIFIES FOR THE EXEMPTION  FOR  A  PARTICULAR  EVALUATION
 PERIOD;
   (IV)  A  HEALTH  CARE PROFESSIONAL SHALL NOT BE REQUIRED TO REQUEST AN
 EXEMPTION TO QUALIFY FOR THE EXEMPTION UNDER THIS PARAGRAPH;
   (V) A  HEALTH  CARE  PROFESSIONAL'S  EXEMPTION  FROM  PREAUTHORIZATION
 REQUIREMENTS  UNDER  SUBPARAGRAPH  (I) OF THIS PARAGRAPH SHALL REMAIN IN
 EFFECT UNTIL:
   (A) THE THIRTIETH DAY AFTER THE DATE THE HEALTH CARE PLAN NOTIFIES THE
 HEALTH CARE PROFESSIONAL OF THE   HEALTH CARE  PLAN'S  DETERMINATION  TO
 RESCIND  THE  EXEMPTION PURSUANT TO SUBPARAGRAPH (VII) OF THIS PARAGRAPH
 IF THE HEALTH CARE PROFESSIONAL DOES NOT APPEAL SUCH DETERMINATION; OR
   (B) WHERE THE HEALTH CARE PROFESSIONAL APPEALS THE  DETERMINATION  AND
 THE  INDEPENDENT  REVIEW  ORGANIZATION  AFFIRMS  THE  HEALTH CARE PLAN'S
 DETERMINATION TO RESCIND THE EXEMPTION, THE FIFTH DAY AFTER THE AFFIRMA-
 TION OF SUCH DETERMINATION;
   (VI) WHERE A HEALTH CARE PLAN DOES NOT FINALIZE A RESCISSION  DETERMI-
 NATION  AS SPECIFIED IN SUBPARAGRAPH (VII) OF THIS PARAGRAPH, THE HEALTH
 CARE PROFESSIONAL SHALL BE  CONSIDERED  TO  HAVE  MET  THE  CRITERIA  TO
 CONTINUE TO QUALIFY FOR THE EXEMPTION AND SUCH EXEMPTION SHALL REMAIN IN
 EFFECT UNTIL THE FOLLOWING EVALUATION PERIOD;
   (VII)  A  HEALTH  CARE  PLAN MAY RESCIND AN EXEMPTION FROM PREAUTHORI-
 ZATION REQUIREMENTS UNDER SUBPARAGRAPH (I) OF THIS PARAGRAPH ONLY:
   (A) DURING JANUARY OR JUNE OF EACH YEAR; AND
   (B) THE HEALTH CARE PLAN MAKES A DETERMINATION,  ON  THE  BASIS  OF  A
 RETROSPECTIVE  REVIEW  OF  A RANDOM SAMPLE OF NOT FEWER THAN FIVE AND NO
 MORE THAN TWENTY CLAIMS SUBMITTED BY THE HEALTH CARE PROFESSIONAL DURING
 THE MOST RECENT EVALUATION PERIOD THAT LESS THAN NINETY PERCENT  OF  THE
 CLAIMS  FOR THE PARTICULAR HEALTH CARE SERVICE MET THE MEDICAL NECESSITY
 CRITERIA THAT WOULD HAVE BEEN  USED  BY  THE    HEALTH  CARE  PLAN  WHEN
 S. 8299                             4

 CONDUCTING  PREAUTHORIZATION  REVIEW  FOR  THE  PARTICULAR  HEALTH  CARE
 SERVICE DURING THE RELEVANT EVALUATION PERIOD; AND
   (C)  THE  HEALTH CARE PLAN COMPLIES WITH ALL OTHER APPLICABLE REQUIRE-
 MENTS OF THIS PARAGRAPH AND THE HEALTH CARE  PLAN  NOTIFIES  THE  HEALTH
 CARE  PROFESSIONAL NOT LESS THAN TWENTY DAYS BEFORE THE PROPOSED RESCIS-
 SION IS TO TAKE EFFECT, TOGETHER WITH THE SAMPLE OF CLAIMS USED TO  MAKE
 THE  DETERMINATION  PURSUANT  TO  CLAUSE  (B) OF THIS SUBPARAGRAPH AND A
 PLAIN LANGUAGE EXPLANATION OF THE HEALTH CARE  PROFESSIONAL'S  RIGHT  TO
 APPEAL  SUCH  DETERMINATION  AND  INSTRUCTIONS  ON  HOW TO INITIATE SUCH
 APPEAL;
   (VIII) NOTWITHSTANDING ANY CONTRARY PROVISION OF SUBPARAGRAPH  (I)  OF
 THIS PARAGRAPH, A HEALTH CARE PLAN MAY DENY AN EXEMPTION FROM PREAUTHOR-
 IZATION REQUIREMENTS:
   (A) IF THE HEALTH CARE PROFESSIONAL DOES NOT HAVE THE EXEMPTION AT THE
 TIME OF THE RELEVANT EVALUATION PERIOD; AND
   (B)  THE  HEALTH  CARE PLAN PROVIDES THE HEALTH CARE PROFESSIONAL WITH
 ACTUAL STATISTICS AND DATA FOR  THE  RELEVANT  PREAUTHORIZATION  REQUEST
 EVALUATION  PERIOD  AND  DETAILED  INFORMATION SUFFICIENT TO DEMONSTRATE
 THAT THE HEALTH CARE PROFESSIONAL DOES NOT  MEET  THE  CRITERIA  FOR  AN
 EXEMPTION PURSUANT TO SUBPARAGRAPH (I) OF THIS PARAGRAPH FOR THE PARTIC-
 ULAR HEALTH CARE SERVICE;
   (IX) AFTER A FINAL DETERMINATION OR REVIEW AFFIRMING THE RESCISSION OR
 DENIAL  OF  AN  EXEMPTION  FOR A SPECIFIC HEALTH CARE SERVICE UNDER THIS
 PARAGRAPH, A HEALTH CARE PROFESSIONAL SHALL BE  ELIGIBLE  FOR  CONSIDER-
 ATION  OF AN EXEMPTION FOR THE SAME HEALTH CARE SERVICE AFTER THE EVALU-
 ATION PERIOD FOLLOWING THE EVALUATION PERIOD WHICH FORMED THE  BASIS  OF
 THE RESCISSION OR DENIAL OF AN EXEMPTION;
   (X)  THE HEALTH CARE PLAN SHALL, NOT LATER THAN FIVE DAYS AFTER QUALI-
 FYING FOR AN EXEMPTION PURSUANT TO SUBPARAGRAPH (I) OF  THIS  PARAGRAPH,
 PROVIDE TO A HEALTH CARE PROFESSIONAL A NOTICE THAT SHALL INCLUDE:
   (A)  A  STATEMENT  THAT  THE HEALTH CARE PROFESSIONAL QUALIFIES FOR AN
 EXEMPTION PURSUANT TO THIS PARAGRAPH;
   (B) A DESCRIPTION OF THE HEALTH CARE SERVICES TO WHICH SUCH  EXEMPTION
 APPLIES; AND
   (C)  A  STATEMENT  OF THE DURATION THAT SUCH EXEMPTION SHALL REMAIN IN
 EFFECT; AND
   (XI) IN THE EVENT THAT THE HEALTH CARE PROFESSIONAL SUBMITS  A  PREAU-
 THORIZATION  REQUEST FOR A HEALTH CARE SERVICE FOR WHICH THE HEALTH CARE
 PROFESSIONAL QUALIFIES FOR AN EXEMPTION FROM  PREAUTHORIZATION  REQUIRE-
 MENTS  UNDER  SUBPARAGRAPH  (I) OF THIS PARAGRAPH,  THE HEALTH CARE PLAN
 SHALL PROMPTLY NOTIFY SUCH HEALTH CARE  PROFESSIONAL  THAT  SUCH  HEALTH
 CARE  PROFESSIONAL  HAS  QUALIFIED FOR AN EXEMPTION FOR SUCH HEALTH CARE
 SERVICE IN ACCORDANCE WITH THE REQUIREMENTS OF SUBPARAGRAPH (X) OF  THIS
 PARAGRAPH.
   (XII) NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO: (A) AUTHORIZE A
 HEALTH  CARE  PROFESSIONAL  TO PROVIDE A HEALTH CARE SERVICE OUTSIDE THE
 SCOPE OF SUCH HEALTH CARE PROFESSIONAL'S APPLICABLE  LICENSE;    OR  (B)
 PROHIBIT  A  HEALTH  CARE PLAN FROM PERFORMING A RETROSPECTIVE REVIEW OF
 THE HEALTH CARE SERVICE PURSUANT TO SECTION FORTY-NINE HUNDRED THREE  OF
 THIS TITLE.
   § 3. This act shall take effect on the one hundred eightieth day after
 it shall have become a law.

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Senate Bill S8299

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Sponsored By

Neil D. Breslin