Bill Text: NY A08035 | 2023-2024 | General Assembly | Introduced

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Bill Title: Requires insurers to provide electronic notification when prior authorization is required to fill a prescription if requested by the insured.

Spectrum: Partisan Bill (Democrat 2-0)

Status: (Introduced) 2024-01-03 - referred to insurance [A08035 Detail]

Download: New_York-2023-A08035-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          8035

                               2023-2024 Regular Sessions

                   IN ASSEMBLY

                                   September 13, 2023
                                       ___________

        Introduced  by M. of A. STECK -- read once and referred to the Committee
          on Insurance

        AN ACT to amend the insurance law and the public health law, in relation
          to electronic notification when prior  authorization  is  required  to
          fill a prescription

          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:

     1    Section 1. Paragraphs 13 and 14 of subsection (b) of section 3217-a of
     2  the insurance law, as added by section 2 of part H of chapter 60 of  the
     3  laws  of  2014,  are  amended and a new paragraph 15 is added to read as
     4  follows:
     5    (13) disclose whether a health care provider scheduled  to  provide  a
     6  health care service is an in-network provider; [and]
     7    (14) with respect to out-of-network coverage, disclose the approximate
     8  dollar  amount  that  the insurer will pay for a specific out-of-network
     9  health care service. The insurer shall also inform the  insured  through
    10  such  disclosure  that  such approximation is not binding on the insurer
    11  and that the approximate dollar amount that the insurer will pay  for  a
    12  specific out-of-network health care service may change[.]; and
    13    (15)  where  applicable,  allow  an  insured  to request an electronic
    14  notification within thirty days when prior authorization is required  to
    15  fill a prescription.
    16    §  2.  Paragraphs  13  and 14 of subsection (b) of section 4324 of the
    17  insurance law, as added by section 9 of part H of chapter 60 of the laws
    18  of 2014, are amended and a new paragraph 15 is added to read as follows:
    19    (13) disclose whether a health care provider scheduled  to  provide  a
    20  health care service is an in-network provider; [and]
    21    (14) with respect to out-of-network coverage, disclose the approximate
    22  dollar  amount  that the corporation will pay for a specific out-of-net-
    23  work health care service. The corporation shall also inform the  insured
    24  through  such  disclosure  that such approximation is not binding on the

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD13192-01-3
        A. 8035                             2

     1  corporation and that the approximate dollar amount that the  corporation
     2  will   pay  for  a  specific  out-of-network  health  care  service  may
     3  change[.]; and
     4    (15)  where  applicable,  allow  an  insured  to request an electronic
     5  notification within thirty days when prior authorization is required  to
     6  fill a prescription.
     7    §  3.  Paragraphs  (m) and (n) of subdivision 2 of section 4408 of the
     8  public health law, as added by section 19 of part H of chapter 60 of the
     9  laws of 2014, are amended and a new paragraph (o) is added  to  read  as
    10  follows:
    11    (m)  disclose  whether  a  health care provider scheduled to provide a
    12  health care service is an in-network provider; [and]
    13    (n) with respect to out-of-network coverage, disclose the  approximate
    14  dollar  amount  that  the health maintenance organization will pay for a
    15  specific out-of-network health  care  service.  The  health  maintenance
    16  organization  shall also inform an enrollee through such disclosure that
    17  such approximation is not binding on the health maintenance organization
    18  and that the approximate  dollar  amount  that  the  health  maintenance
    19  organization  will pay for a specific out-of-network health care service
    20  may change[.]; and
    21    (o) where applicable,  allow  an  insured  to  request  an  electronic
    22  notification  within thirty days when prior authorization is required to
    23  fill a prescription.
    24    § 4. This act shall take effect immediately.