BILL NUMBER: S7297
SPONSOR: HOYLMAN-SIGAL
 
TITLE OF BILL:
An act to amend the public health law and the insurance law, in relation
to utilization review program standards and pre-authorization of health
care services
 
PURPOSE OR GENERAL IDEA OF BILL:
The purpose of this legislation is to reduce administrative requirements
of health care practitioners which interfere with efforts to assure
patients receive appropriate care by amending prior authorization and
utilization 6 review procedures imposed by insurance companies:
 
SUMMARY OF SPECIFIC PROVISIONS:
Section 1 amends paragraph (c) of subdivision 1 of section 4902 of the
public health law by adding "such clinical review criteria shall utilize
recognized evidence-based and peer reviewed clinical review criteria
that takes into account the needs of a typical patient populations and
diagnoses."
Section 2 amends paragraph (a) of subdivision 2 of section 4903 of the
public health law by changing from three business days to "seventy-two
hours" the amount of time a utilization review agent shall make and
communicate a determination, adds "or within twenty-four hours of the
receipt of necessary information if the request is for an enrollee with
a medical condition that places the health of the insured in serious
jeopardy without the health care services recommended by the enrollee's
health care professional" and "An approval for a request for pre-author-
ization shall be valid for duration of the prescription, including any
authorized refills, or treatment for a specific condition as requested
by the enrollee's health care provider."
Section 3 amends paragraph 3 of subsection (a) of section 4902 of the
insurance law by adding "such clinical review criteria shall utilize
recognized evidence-based and peer-reviewed clinical review criteria
that takes into account the needs of a typical patient populations and
diagnoses."
Section 4 amends paragraph 1 of subsection (b) of section 4903 the
insurance law by changing from three business days to "seventy-two
hours" the amount of time a utilization review agent shall make and
communicate a determination adds "within twenty-four hours of the
receipt of necessary information if the request is for an insured with a
medical condition that places the health of the insured in serious
 
EFFECTIVE DATE:
90 days after it shall have become a law.

Statutes affected:
S7297: 4902 public health law, 4902(1) public health law, 4902 insurance law, 4902(a) insurance law