NY State Senate Bill 2023-S9858

Senate Bill S9858

2023-2024 Legislative Session

Establishes a mandated window of five business days for both Medicaid and private insurers to respond to pre-authorization claims for testing and/or treatments made by physicians on behalf of oncology patients

download bill text pdf

Current 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 06, 2024	referred to rules

2023-S9858 (ACTIVE) - Details

See Assembly Version of this Bill:: A10679
Current Committee:: Senate Rules
Law Section:: Insurance Law
Laws Affected:: Amd §3238, Ins L

2023-S9858 (ACTIVE) - Summary

2023-S9858 (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S9858

SPONSOR: PERSAUD
 
TITLE OF BILL:

An act to amend the insurance law, in relation to establishing a
mandated window of five business days for both Medicaid and private
insurers to respond to pre-authorization claims for testing and/or
treatments made by physicians on behalf of oncology patients

 
PURPOSE OR GENERAL IDEA OF BILL:

This bill provides for swifter action from Medicaid and private insurers
to respond to a physicians pre-authorization for needed oncology testing
and/or treatment so that a patient receives the care needed to save
their lives.

 
SUMMARY OF SPECIFIC PROVISIONS:

Section 1 of the bill adds a new paragraph 7 to section 1 subsection (a)
of section 3238 of the insurance law that would mandates a waiting peri-
od of five business days be established in which an insurer must respond

to oncology testing and/or treatment preauthorization.

Section 2 sets the effective date.

 
JUSTIFICATION:

Due to the immensely long wait time that patients face for preauthori-
zation claims from insurance companies, this legislation would enact a
five day window for preauthorization claims which if a patient had not
received a response from their insurer, a physician would be granted the
ability to sign off on potentially lifesaving oncology testing or treat-
ment.

As it currently stands, patients in dire need of oncology testing and
treatment are forced to wait long and indefinite periods of time waiting
for preauthorization. This legislation would make a big impact on cancer
patients in their pursuit of lifesaving care.

 
PRIOR LEGISLATIVE HISTORY:

New Bill.

 
FISCAL IMPLICATIONS:

None noted.

 
EFFECTIVE DATE:
This act shall take effect immediately.

2023-S9858 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   9858
 
                             I N  S E N A T E
 
                               June 6, 2024
                                ___________
 
 Introduced  by  Sen. PERSAUD -- read twice and ordered printed, and when
   printed to be committed to the Committee on Rules
 
 AN ACT to amend  the  insurance  law,  in  relation  to  establishing  a
   mandated  window  of  five business days for both Medicaid and private
   insurers to respond to pre-authorization  claims  for  testing  and/or
   treatments made by physicians on behalf of oncology patients

   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subsection (a) of section 3238  of  the  insurance  law  is
 amended by adding a new paragraph 7 to read as follows:
   (7)  WITH  REGARD  TO CLAIMS OF PRE-AUTHORIZATION FILED BY A PHYSICIAN
 WITH PRIVATE INSURERS AND/OR MEDICAID ON BEHALF OF AN ONCOLOGY  PATIENT,
 IT  IS  HEREBY  MANDATED  THAT A WAITING PERIOD OF FIVE BUSINESS DAYS BE
 ESTABLISHED IN WHICH AN INSURER MUST RESPOND TO SUCH A CLAIM. IF IN SUCH
 A CASE THE INSURER DOES NOT RENDER A DECISION AND NOTIFY  THE  PHYSICIAN
 WITHIN  THE  PERIOD OF FIVE BUSINESS DAYS FOLLOWING THE FILING OF A PRE-
 AUTHORIZATION CLAIM, THE PHYSICIAN DEEMED RESPONSIBLE FOR  TREATING  THE
 PATIENT  IS  AUTHORIZED TO CONDUCT THE LIFESAVING TESTING, TREATMENT, OR
 PROCEDURE AND AS SUCH, THE INSURER  WILL  BE  MADE  LIABLE  FOR  PAYMENT
 COVERING THE PRESCRIBED METHOD OF CARE.
   § 2. This act shall take effect immediately.
 
 
 
 
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD15856-01-4

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