New York S 7470: Requires insurers and health plans to grant automatic preauthorization approvals to eligible health care professionals in certain circumstance

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S07470 Summary:

BILL NOS07470 

&nbsp

SAME ASNo Same As

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SPONSORHOYLMAN-SIGAL

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COSPNSRCLEARE, COONEY, GALLIVAN, LIU, RIVERA, SKOUFIS, WEBB

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MLTSPNSR

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Amd §4902, Ins L; amd §4902, Pub Health L

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Requires insurers and health plans to grant automatic preauthorization approvals to eligible health care professionals in certain circumstances.

Go to top S07470 Actions:

BILL NOS07470 

&nbsp

04/17/2025REFERRED TO INSURANCE

Go to topS07470 Committee&nbspVotes:

Go to topS07470 Floor&nbspVotes:

There are no Assembly votes for this bill in this legislative session.

Go to topS07470 Text:

 STATE OF NEW YORK
 ________________________________________________________________________

 7470

 2025-2026 Regular Sessions

 IN SENATE

 April 17, 2025
 ___________

 Introduced by Sens. HOYLMAN-SIGAL, CLEARE, COONEY, GALLIVAN, RIVERA,
 SKOUFIS, WEBB -- read twice and ordered printed, and when printed to
 be committed to the Committee on Insurance

 AN ACT to amend the insurance law and the public health law, in relation
 to requiring insurers and health plans to grant automatic preauthori-
 zation approvals to eligible health care professionals in certain
 circumstances

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

 1 Section 1. Subsection (a) of section 4902 of the insurance law is
 2 amended by adding a new paragraph 17 to read as follows:
 3 (17) Establishment of automatic preauthorization approval requirements
 4 for insurers to provide to health care professionals providing health
 5 care services which shall include that:
 6 (i) an insurer that uses a preauthorization process for health care
 7 services shall provide an automatic preauthorization approval to a
 8 health care professional for a particular health care service, as
 9 defined under this title including but not limited to health care proce-
 10 dures, treatments, services, pharmaceutical products, services or dura-
 11 ble medical equipment if, in the most recent six-month evaluation peri-
 12 od, the insurer has approved not less than ninety percent of the
 13 preauthorization requests submitted by such health care professional for
 14 the particular health care service. For the purposes of this require-
 15 ment, a preauthorization request submitted during the evaluation period
 16 shall be considered and counted as a single request and single approval
 17 if the request was approved at any point between the date the request
 18 was submitted by the health care professional and the final determi-
 19 nation by the insurer, including any re-review or appeal process. Each
 20 insurer shall complete its initial evaluation and issue its determi-
 21 nation to each health care professional in its network no later than one
 22 hundred eighty days after the effective date of this paragraph. The

 EXPLANATION--Matter in italics (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD01540-02-5

 S. 7470 2

 1 automatic preauthorization approval shall become effective two hundred
 2 twenty-five days after the effective date of this paragraph;
 3 (ii) after the initial evaluation has been completed the insurer shall
 4 annually thereafter evaluate whether a health care professional quali-
 5 fies for an automatic preauthorization approval under subparagraph (i)
 6 of this paragraph for additional health care services. Each year, the
 7 evaluation shall review preauthorization determinations made in the
 8 first six months of the year. Each insurer shall issue its determination
 9 to each health care professional in its network no later than November
 10 fifteenth to be effective January first of the following year;
 11 (iii) the insurer may continue the automatic preauthorization approval
 12 under subparagraph (i) of this paragraph without evaluating whether the
 13 health care professional qualifies for automatic preauthorization
 14 approval for a particular evaluation period;
 15 (iv) a health care professional shall not be required to request an
 16 automatic preauthorization approval to qualify for such approval;
 17 (v) a health care professional's automatic preauthorization approval
 18 under subparagraph (i) of this paragraph shall remain in effect until