What's happening
This bill prohibits health insurance plans from requiring prior authorization for neonatal intensive care services, while allowing denial if not medically necessary.
Why it matters
Hospital-specific scope. The change would apply across New York to neonatal intensive care services in general hospitals certified under Article 28, rather than to every setting providing newborn care.
Parallel legal changes. The bill would add matching provisions to the Public Health Law and two sections of the Insurance Law, covering health care plans, insurers and corporations organized under the relevant insurance article.
Short implementation window. The new rules would take effect 60 days after becoming law, giving covered plans that period to adjust authorization procedures for hospital neonatal intensive care.
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Who cares
Hospitals with neonatal intensive care units
Certified general hospitals would no longer need to obtain advance plan approval for services provided in those units.
Families of newborns in intensive care
The bill would remove an advance coverage approval requirement for their infants’ care, without guaranteeing payment of every claim.
Health plans and insurers
Covered entities would need to change prior authorization practices while retaining the ability to deny claims later on medical-necessity grounds.
Headline styles
End NICU Pre-Approval Rules
Plain English, a few words. Used as the page title.
Sponsors
1 Co-sponsor
History
- Signed chap.389
- Delivered to governor
- Returned to senate
- Passed assembly
- Ordered to third reading rules cal.310
- Substituted for A8051
- Referred to codes
- Delivered to assembly
- Passed senateVote 63–0
- Advanced to third reading
- 2nd report cal.
- 1st report cal.1158
Show 1 earlier action
- Referred to health
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
Assembly Floor Calendar · Sponsor Richard Gottfried
Full text
1 pageUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
6053
2017-2018 Regular Sessions
IN SENATE
May 10, 2017
Introduced by Sen. HANNON -- read twice and ordered printed, and when printed to be committed to the Committee on Health
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.
Sponsor's memo
Title of bill
An act to amend the public health law and the insurance law, in relation to health care coverage for neonatal intensive care services
Purpose
To clarify that a health plan shall not require a prior authorization determination for services provided in a neonatal intensive care unit of a general hospital, provided however the plan may deny a claim for such services if it is determined it was not medically necessary.
Summary of provisions
Sections 1 through 3 of the bill amend section 4406-c of the public health law and sections 3217b and 4325 of the insurance law to provide that insurers shall not require a prior authorization determination for services provided in a neonatal intensive care unit of a general hospital, provided however insurers may deny a claim for such services if the services are subsequently determine not medically necessary.
Section 4 of the bill provides for an effective date.
Justification
A number of health insurers have been denying payments to providers for neonatal intensive care unit (NICU) services, solely on an administrative basis, without any determination made on the clinical validity of the services provided. This bill prevents health insurers from denying NICU services on the sole basis that prior authorization was not received.
The decision to admit a newborn into the NICU is based on the infant's unique clinical situation. This bill removes an unnecessary administrative barrier to care by amending the Public Health and Insurance laws to prohibit health insurers from requiring prior authorization for services provided in a NICU. This bill does not change the ability of health insurers to make a medical necessity determination and from denying a claim for such services if not medically necessary; however, they would not be able to deny the claim for purely administrative reasons.
Legislative history
New bill
Fiscal implications
None
Effective date
60th day after it shall become law.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.