Bill Text: NY A10268 | 2015-2016 | General Assembly | Amended

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Bill Title: Limits denial of coverage of additional treatment related to health care services for which pre-authorization is required and was granted.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Engrossed - Dead) 2016-06-16 - REFERRED TO RULES [A10268 Detail]

Download: New_York-2015-A10268-Amended.html

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                STATE OF NEW YORK
        ________________________________________________________________________
                                        10268--A
                   IN ASSEMBLY
                                      May 19, 2016
                                       ___________
        Introduced by M. of A. HUNTER -- read once and referred to the Committee
          on  Insurance -- committee discharged, bill amended, ordered reprinted
          as amended and recommitted to said committee
        AN ACT to amend the insurance law, in relation to denial of coverage  of
          treatment  related to health care services for which pre-authorization
          was granted
          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:
     1    Section  1.  Section  3238 of the insurance law is amended by adding a
     2  new subsection (c-1) to read as follows:
     3    (c-1) If a health plan denies payment for the treatment of  concurrent
     4  symptoms  or  side  effects  due  to  lack of pre-authorization and such
     5  treatment is rendered at the same time as  a  health  care  service  for
     6  which  pre-authorization  was  required and received, upon the appeal of
     7  the denial, the denial of any such service shall be upheld only if it is
     8  determined that:
     9    (1) the treatment is not a covered benefit;
    10    (2) the treatment was not medically necessary pursuant to section four
    11  thousand nine hundred four of this chapter or section forty-nine hundred
    12  four of the public health law;
    13    (3) the treatment was  experimental  or  investigational  pursuant  to
    14  section  four  thousand  nine  hundred  four  of this chapter or section
    15  forty-nine hundred four of the public health law; or
    16    (4) one of the conditions set forth in paragraphs one through  six  of
    17  subsection (a) of this section is met.
    18    §  2.  This  act shall take effect on the ninetieth day after it shall
    19  have become a law.
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD15457-03-6