What's happening
This bill requires health insurers and health plans to annually provide updated lists of services needing preauthorization, with advance notice for changes.
Why it matters
Limits insurer discretion by requiring that only services on the annually updated and disclosed preauthorization list can actually be subjected to preauthorization. this restricts insurers from springing surprise requirements on doctors or patients.
Mandates that lists of preauthorization requirements must be developed with input from relevant medical specialty organizations and local physicians. making the process more clinically grounded and responsive to local practice standards.
Requires at least 90 days advance notice before any new service is added to the preauthorization list. , giving healthcare providers time to adapt their administrative processes and inform patients, potentially reducing delays or disruptions in care.
Enhances transparency and predictability for both healthcare providers and patients. , aiming to reduce administrative burdens, confusion, and last-minute insurance denials that can interfere with timely medical treatment.
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Who cares
Health insurers and health care plans
They would have to distribute lists of services requiring prior authorization, update them at least annually and limit authorization requirements to listed services.
Participating physicians and health care providers
They would receive at least 90 days’ notice before insurers or plans add services to their prior authorization lists.
Regional physicians and medical specialty organizations
Insurers and plans would have to consult appropriately trained local physicians and specialty organizations’ medical guidelines when developing the lists.
Superintendent of Financial Services
The bill would authorize the superintendent to issue rules and take other measures needed to implement its requirements.
Headline styles
Require Disclosure of Preauthorization List
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Referred to insurance
- 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.
Disclose Insurance Preauthorization Lists
In Senate Committee · Insurance · Sponsor Jamaal Bailey
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
1187
2019-2020 Regular Sessions
IN ASSEMBLY
January 14, 2019
Introduced by M. of A. JOYNER -- read once and referred to the Committee on Insurance
AN ACT to amend the insurance law and the public health law, in relation to enacting the "health insurance preauthorization disclosure act"
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Short title. This act shall be known and may be cited as the "health insurance preauthorization disclosure act".
§ 2. The insurance law is amended by adding a new section 4242 to read as follows:
§ 4242. Health insurance companies; preauthorization for health care services. Every health care insurance company shall be required to provide participating physicians and health care providers, as defined in subdivision seven of section twenty-nine hundred eighty of the public health law, with an updated list of health care treatments and services that require preauthorization or precertification from such health care insurance company. Such list shall be developed based upon consultation with medical guidelines developed by the relevant medical specialty organization and in consultation with appropriately trained physicians practicing within the region the health care insurance company serves. Such list shall be updated annually or more frequently as appropriate. Only those health care services which are contained on such list shall be subject to pre-authorization or precertification by the health care insurance company. No health care treatment or service shall be added to the list of services requiring pre-authorization or precertification unless the health care insurance company provides a minimum of ninety days notice to participating physicians and health care providers.
§ 3. The public health law is amended by adding a new section 4905-a to read as follows:
§ 4905-a. Pre-authorized services. Every health care plan shall be required to develop and provide to participating health care providers a
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD00098-01-9
A. 1187 2
list of health care services that require pre-authorization or precertification from such health care plan. Such list shall be developed based upon consultation with medical guidelines developed by the relevant medical specialty organization and in consultation with appropriately trained physicians practicing within the region the health care plan serves. Such list shall be updated annually or more frequently as appropriate. Only those health care services which are contained on such list shall be subject to pre-authorization or precertification by the health care plan. No health care service shall be added to the list of services requiring pre-authorization or precertification unless the health care plan provides a minimum of ninety days notice to participating health care providers.
§ 4. The insurance law is amended by adding a new section 4905-a to read as follows:
§ 4905-a. Pre-authorized services. Every health care plan shall be required to develop and provide to participating health care providers a list of health care services that require pre-authorization or precertification from such health care plan. Such list shall be developed based upon consultation with medical guidelines developed by the relevant medical specialty organization and in consultation with appropriately trained physicians practicing within the region the health care plan serves. Such list shall be updated annually or more frequently as appropriate. Only those health care services which are contained on such list shall be subject to pre-authorization or precertification by the health care plan. No health care service shall be added to the list of services requiring pre-authorization or precertification unless the health care plan provides a minimum of ninety days notice to participating health care providers.
§ 5. This act shall take effect on the sixtieth day after it shall have become a law; provided, however that the superintendent of financial services is hereby authorized to promulgate all rules and regulations and take any other measures necessary to implement this act on its effective date.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
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