What's happening
This bill prohibits health insurance plans from requiring prior authorization for neonatal intensive care services but allows denial if not medically necessary.
Why it matters
Speeds up access to critical care for newborns. By eliminating prior authorization requirements for neonatal intensive care, the bill aims to prevent administrative delays that could negatively impact the health of critically ill infants.
Reduces administrative burden on families and providers. Parents and hospital staff would not have to navigate time-consuming insurance paperwork during urgent neonatal situations, allowing them to focus on immediate medical needs.
Maintains checks for medical necessity. While prior authorization is waived, insurance plans can still deny coverage if services are later found to be medically unnecessary, preserving a safeguard against unnecessary or inappropriate care.
Could impact insurance costs and hospital billing practices. The bill may shift the way insurers and hospitals approach neonatal intensive care claims, potentially affecting future negotiations, billing timelines, and overall healthcare costs in this high-expense area.
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Who cares
Families of newborns receiving intensive care
The bill would bar health plans and insurers from requiring prior authorization for services in neonatal intensive care units at certified general hospitals.
General hospitals with neonatal intensive care units
The bill would remove prior authorization requirements for NICU services, but claims could still be denied if those services are later determined not medically necessary.
Health plans and insurers
They would have to stop requiring prior authorization for covered NICU services while retaining the ability to deny claims based on subsequent medical necessity determinations.
Headline styles
End NICU Pre-Approval Rules
Plain English, a few words. Used as the page title.
Sponsors
2 Co-sponsors
History
- Substituted by S6053
- Ordered to third reading rules cal.310
- Rules report cal.310
- Reported
- Reported referred to rules
- Reported referred to codes
- 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.
End NICU Pre-Approval Rules
Signed by Governor · Sponsor Kemp Hannon
Full text
1 pageUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
8051
2017-2018 Regular Sessions
IN ASSEMBLY
May 25, 2017
Introduced by M. of A. GOTTFRIED -- read once and referred to the Committee on Insurance
AN ACT to amend the public health law and the insurance law, in relation to health care coverage for neonatal intensive care services
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Section 4406-c of the public health law is amended by adding a new subdivision 9 to read as follows:
9. A health care plan shall not require a prior authorization determination for services provided in a neonatal intensive care unit of a general hospital certified pursuant to article twenty-eight of this chapter. Nothing in this subdivision shall prohibit a health care plan from denying a claim for such services if the services are subsequently determined not medically necessary.
§ 2. Section 3217-b of the insurance law is amended by adding a new subsection (k) to read as follows:
(k) An insurer shall not require a prior authorization determination for services provided in a neonatal intensive care unit of a general hospital certified pursuant to article twenty-eight of the public health law. Nothing in this subsection shall prohibit an insurer from denying a claim for such services if the services are subsequently determined not medically necessary.
§ 3. Section 4325 of the insurance law is amended by adding a new subsection (l) to read as follows:
(1) A corporation organized under this article shall not require a prior authorization determination for services provided in a neonatal intensive care unit of a general hospital certified pursuant to article twenty-eight of the public health law. Nothing in this subsection shall prohibit a corporation organized under this article from denying a claim for such services if the services are subsequently determined not medically necessary.
§ 4. This act shall take effect on the sixtieth day after it shall have become a law.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD11617-01-7
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.