S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5375
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 13, 2025
                                ___________
 
 Introduced by M. of A. WEPRIN -- read once and referred to the Committee
   on Insurance
 
 AN  ACT  to  amend  the  insurance  law  and the social services law, in
   relation to prohibiting health insurers, including medical  assistance
   programs, from imposing arbitrary time caps on reimbursement for anes-
   thesia services

   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. The insurance law is amended by adding a new  section  3246
 to read as follows:
   § 3246. PROHIBITION ON ARBITRARY TIME CAPS FOR ANESTHESIA SERVICES. 1.
 AN  INSURER  ISSUING  A POLICY OF HOSPITAL, MEDICAL, OR SURGICAL EXPENSE
 INSURANCE PURSUANT TO THIS SECTION OR ANY OTHER SECTION OF LAW SHALL NOT
 IMPOSE ARBITRARY TIME CAPS  ON  REIMBURSEMENT  FOR  ANESTHESIA  SERVICES
 PROVIDED DURING MEDICALLY NECESSARY PROCEDURES.
   2.  REIMBURSEMENT FOR ANESTHESIA SERVICES SHALL BE DETERMINED BASED ON
 MEDICAL NECESSITY AS  ASSESSED  BY  THE  ATTENDING  ANESTHESIOLOGIST  OR
 LICENSED ANESTHESIA PROVIDER.
   3.  AN  INSURER  ISSUING  A  POLICY  OF HOSPITAL, MEDICAL, OR SURGICAL
 EXPENSE INSURANCE PURSUANT TO THIS SECTION OR ANY OTHER SECTION  OF  LAW
 SHALL  BE PROHIBITED FROM DENYING PAYMENT FOR ANESTHESIA SERVICES SOLELY
 BECAUSE THE DURATION OF CARE EXCEEDED A PRE-SET TIME LIMIT.
   4. THE DEPARTMENT OF HEALTH SHALL:
   (A) CONDUCT PERIODIC AUDITS OF HEALTH INSURERS  TO  ACCESS  COMPLIANCE
 WITH THE PROVISIONS OF THIS SECTION; AND
   (B)  INVESTIGATE  ALLEGATIONS  OF NONCOMPLIANCE WITH THE PROVISIONS OF
 THIS SECTION BY PATIENTS, PROVIDERS AND OTHER STAKEHOLDERS.
   5. NOT LATER THAN ONE YEAR FROM THE EFFECTIVE DATE  OF  THIS  SECTION,
 AND  EVERY THREE YEARS THEREAFTER, THE DEPARTMENT OF HEALTH SHALL SUBMIT
 A REPORT TO THE SPEAKER OF THE ASSEMBLY AND THE TEMPORARY  PRESIDENT  OF
 THE SENATE. SUCH REPORT SHALL INCLUDE:
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD09176-01-5
              

 A. 5375                             2
 
   (A)  THE FINDINGS OF ANY AUDITS CONDUCTED PURSUANT TO PARAGRAPH (A) OF
 SUBDIVISION FOUR OF THIS SECTION;
   (B)  THE  NUMBER  AND  NATURE  OF VIOLATIONS OF THE PROVISIONS OF THIS
 SECTION REPORTED; AND
   (C)  RECOMMENDATIONS,  IF  ANY,  FOR  IMPROVING  COMPLIANCE  WITH  THE
 PROVISIONS OF THIS SECTION.
   §  2. The social services law is amended by adding a new section 365-q
 to read as follows:
   § 365-Q. PROHIBITION ON ARBITRARY TIME CAPS FOR  ANESTHESIA  SERVICES.
 ANY  MEDICAL  ASSISTANCE  PROVIDER WHOSE MEDICAL ASSISTANCE INCLUDES THE
 PROVISION OF ANESTHESIA, INCLUDING SUCH ASSISTANCE FURNISHED  THROUGH  A
 MANAGED  CARE  PROGRAM,  SHALL  NOT BE SUBJECT TO ARBITRARY TIME CAPS ON
 REIMBURSEMENT WHEN FURNISHED DURING MEDICALLY NECESSARY  PROCEDURES,  AS
 DETERMINED  BY  THE ATTENDING ANESTHESIOLOGIST OR OTHER PROVIDER OF SUCH
 ANESTHESIA, AND SUCH PAYMENT SHALL NOT BE  DENIED  FOR  SUCH  ASSISTANCE
 SOLELY  BECAUSE  THE DURATION OF SUCH ASSISTANCE EXCEEDED A PRE-SET TIME
 LIMIT.
   § 3. This act shall take effect immediately.