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Sponsors
Senator · Senate District 38
No co-sponsors yet.
History
- Referred to insurance
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Shortens time frames during which an insurer has to determine whether a pre-authorization request is medically necessary
In Assembly Committee · Insurance · Sponsor Edward Braunstein
Full text
The text isn't available here yet. Check nysenate.gov.
Sponsor's memo
BILL NUMBER:S6459
Title of bill
An act to amend the insurance law and the public health law, in relation to shortening time frames during which an insurer has to determine whether a pre-authorization request is medically necessary
Purpose
To shorten time frames during which an insurer has to deter- mine whether a pre-authorization request is medically necessary.
Summary of provisions
Section 1. Amends Subsection (b) of section 4903 of the insurance law to require that a utilization review agent shall make a determination involving health care services which require pre-authorization and provide notice of the determination to the insured by telephone and in writing within three days, rather than three business days, of receipt of the necessary information.
Section 2. Amends subdivision 2 of section 4903 of the public health law to require that a utilization review agent shall make a utilization review determination involving health care services which require pre- authorization and provide notice of a determination to the enrollee by telephone and in writing within three days of receipt of the necessary information.
Section 3. Effective date.
Justification
Hospitalized patients must receive pre-authorization from their insurance companies in order to have some health care services covered, including the transfer of a patient from a hospital to a nursing home or rehabilitation center. Currently, the timeframe within which insurance companies must issue this determination is three busi- ness days. However, this time frame is too long for many patients, particularly over long holiday weekends. During holiday weekends, the patient must wait an additional three to four days in the hospital with- out beginning to recover.
The current time frame prevents many patients from leaving the hospital as they prepare to be transferred to a rehabilitation facility. These rehabilitation facilities are often prepared to accept the patient, but cannot do so without pre-authorization from the insurance company.
Many of these insurance companies already have customer service repre- sentatives available during these days to answer questions from individ- uals or to sign up individuals for coverage. This bill would shorten the time frame within which approval is required so that hospitalized patients can begin the healing process in a timely manner.
Legislative history
New bill.
Fiscal implications
None.
Effective date
This act shall take effect on the same date and in the same manner as section 5 of chapter 514 of the laws of 2013, takes effect.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.