A 6143: Requires out-of-network treatment disclosure within twenty-four hours of approval of certain surgical procedures.

  
  STATE OF NEW YORK ________________________________________________________________________ 6143 2025-2026 Regular Sessions  IN ASSEMBLY February 26, 2025 ___________ Introduced by M. of A. SOLAGES -- read once and referred to the Commit- tee on Health AN ACT to amend the public health law, in relation to out-of-network treatment disclosure for certain surgical procedures The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Subdivision 5 of section 230-d of the public health law, as 2 added by chapter 365 of the laws of 2007, is amended to read as follows: 3 5. Every licensee performing inpatient and/or outpatient surgical care 4 and that requires pre-approval of surgical procedures by the patient's 5 insurance provider shall provide notice to the patient if all or a 6 portion of treatment approved is authorized to be rendered by a provider 7 that is not an in-network provider. Such notification shall be provided 8 to the patient by telephone call, email or text message at the time of 9 approval by the licensee and shall be confirmed by mail not more than 10 twenty-four hours after approval of the surgical procedure. If the 11 licensee fails to provide such notice to the patient at least forty- 12 eight hours prior to the procedure, the licensee shall cover the cost of 13 the procedure as though the services were rendered by an in-network 14 provider. The provisions of this subdivision shall not apply to any 15 surgical procedure performed within twenty-four hours after the insured 16 sustains the injury necessitating the surgical procedure. 17 6. the commissioner shall make, adopt, promulgate and enforce such 18 rules and regulations, as [he or she] the commissioner may deem appro- 19 priate, to effectuate the purposes of this section. Where any rule or 20 regulation under this section would affect the scope of practice of a 21 health care practitioner licensed, registered or certified under title 22 eight of the education law other than those licensed under articles one 23 hundred thirty-one or one hundred thirty-one-B of the education law, the 24 rule or regulation shall be made with the concurrence of the commission- 25 er of education. EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD10211-01-5 
 A. 6143 2 1 § 2. The public health law is amended by adding a new section 2807-g 2 to read as follows: 3 § 2807-g. Notice of out-of-network treatment. Every hospital or other 4 licensed entity providing inpatient and/or outpatient surgical care that 5 requires pre-approval of surgical procedures by the patient's insurance 6 provider shall provide notice to the patient if all or a portion of 7 treatment approved is authorized to be rendered by a provider that is 8 not an in-network provider. Such notification shall be provided to the 9 patient by telephone call, email or text message at the time of approval 10 by such hospital or other licensed entity and shall be confirmed by mail 11 not more than twenty-four hours after approval of the surgical proce- 12 dure. If such hospital or other licensed entity fails to provide such 13 notice to the patient at least forty-eight hours prior to the procedure, 14 such hospital or other licensed entity shall cover the cost of the 15 procedure as though the services were rendered by an in-network provid- 16 er. The provisions of this subdivision shall not apply to any surgical 17 procedure performed within twenty-four hours after the insured sustains 18 the injury necessitating the surgical procedure. 19 § 3. This act shall take effect on the ninetieth day after it shall 20 have become a law.