What's happening
This bill requires Medicaid and private insurers to respond to oncology pre-authorization claims within five business days or cover the prescribed care.
Why it matters
Speeds up access to urgent cancer care. By requiring insurers to respond to oncology pre-authorization requests within five business days, the bill aims to reduce potentially dangerous delays in life-saving cancer treatments and diagnostics.
Reduces administrative barriers for doctors. If an insurer fails to respond in time, the provider can proceed with the recommended care—removing a major hurdle that often forces physicians to wait for insurer approval before treating cancer patients.
Shifts financial risk to insurers for inaction. Insurers who do not meet the five-day deadline become responsible for covering the prescribed oncology care, incentivizing them to process claims more quickly and reliably.
Applies to both public and private coverage. The five-day rule covers Medicaid as well as private insurance, potentially benefitting a wide range of New Yorkers regardless of their insurance source.
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Who cares
Oncology patients
The bill would allow their treating physician to proceed with lifesaving testing, treatment or procedures at the insurer’s expense if a pre-authorization decision is not issued and communicated within five business days.
Physicians treating oncology patients
They would gain authority to provide the prescribed lifesaving care if an insurer fails to decide and notify them within five business days of filing a pre-authorization claim.
Private insurers and Medicaid
They would face a five-business-day deadline to respond to physicians’ oncology pre-authorization claims and liability for the prescribed care if they miss that deadline.
Headline styles
Faster Cancer Treatment Approvals
Plain English, a few words. Used as the page title.
Sponsors
2 Co-sponsors
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.
Speed Up Cancer Care Approval
In Assembly Committee · Insurance · Sponsor Pamela J. Hunter
Full text
1 pageUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
586
2025-2026 Regular Sessions
IN SENATE (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 Assembly, 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 preauthorization 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
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
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.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.