A 9407: Relates to not requiring a prior authorization determination for certain categories of cancer treatments based on National Comprehensive Cancer Network Guidelines.

  
  STATE OF NEW YORK ________________________________________________________________________ 9407 2025-2026 Regular Sessions  IN ASSEMBLY December 19, 2025 ___________ Introduced by M. of A. PAULIN -- read once and referred to the Committee on Insurance AN ACT to amend the insurance law, the public health law and the social services law, in relation to not requiring prior authorization for certain cancer treatments The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Section 3217-b of the insurance law is amended by adding a 2 new subsection (p) to read as follows: 3 (p) No insurer subject to this article shall require a prior authori- 4 zation determination for cancer treatment meeting category one or cate- 5 gory two-A of the National Comprehensive Cancer Network's Categories of 6 Evidence and Consensus, provided that such insurer may require a health 7 care provider to certify that the course of treatment for the oncology 8 patient meets National Comprehensive Cancer Network Guidelines. Nothing 9 in this subsection shall prohibit an insurer from denying a claim for 10 such services if the services are subsequently determined not medically 11 necessary. 12 § 2. Section 4325 of the insurance law is amended by adding a new 13 subsection (p) to read as follows: 14 (p) No corporation organized under this article shall require a prior 15 authorization determination for cancer treatment meeting category one or 16 category two-A of the National Comprehensive Cancer Network's Categories 17 of Evidence and Consensus, provided that such corporation may require a 18 health care provider to certify that the course of treatment for the 19 oncology patient meets National Comprehensive Cancer Network Guidelines. 20 Nothing in this subsection shall prohibit a corporation from denying a 21 claim for such services if the services are subsequently determined not 22 medically necessary. 23 § 3. Section 4406-c of the public health law is amended by adding a 24 new subdivision 14 to read as follows: EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD14275-01-5 
 A. 9407 2 1 14. No health care plan shall require a prior authorization determi- 2 nation for cancer treatment meeting category one or category two-A of 3 the National Comprehensive Cancer Network's Categories of Evidence and 4 Consensus, provided that such health care plan may require a health care 5 provider to certify that the course of treatment for the oncology 6 patient meets National Comprehensive Cancer Network Guidelines. Nothing 7 in this subdivision shall prohibit a health care plan from denying a 8 claim for such services if the services are subsequently determined not 9 medically necessary. 10 § 4. Section 364-j of the social services law is amended by adding a 11 new subdivision 26-d to read as follows: 12 26-d. Managed care providers shall not require a prior authorization 13 determination for cancer treatment meeting category one or category 14 two-A of the National Comprehensive Cancer Network's Categories of 15 Evidence and Consensus, provided that the managed care plan may require 16 a health care provider to certify that the course of treatment for the 17 oncology patient meets National Comprehensive Cancer Network Guidelines. 18 Nothing in this subdivision shall prohibit a managed care plan from 19 denying a claim for such services if the services are subsequently 20 determined not medically necessary. 21 § 5. This act shall take effect on the one hundred eightieth day after 22 it shall have become a law; provided, however, that the amendments to 23 section 364-j of the social services law made by section four of this 24 act shall be subject to the expiration and repeal of such section and 25 shall expire and be deemed repealed therewith.