NY State Senate Bill 2025-S586

Senate Bill S586

2025-2026 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 Insurance 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
Jan 08, 2025	referred to insurance

2025-S586 (ACTIVE) - Details

See Assembly Version of this Bill:: A1462
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §3238, Ins L
Versions Introduced in 2023-2024 Legislative Session:: S9858, A10679

2025-S586 (ACTIVE) - Summary

2025-S586 (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S586

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 physician's pre-authorization for needed oncology test-
ing 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

period 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 is 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:

2024: Referred to Rules

 
FISCAL IMPLICATIONS:

None noted.

 
EFFECTIVE DATE:
This act shall take effect immediately.

2025-S586 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                    586
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                                (PREFILED)
 
                              January 8, 2025
                                ___________
 
 Introduced  by  Sen. PERSAUD -- read twice and ordered printed, and when
   printed to be committed to the Committee on Insurance
 
 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.
                                                            LBD02191-01-5

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