Bill > A02352

This bill requires insurers and health care plans to establish an automatic preauthorization approval process for certain health care professionals. Under the proposed law, if a health care professional has a 90% or higher approval rate for preauthorization requests during a six-month evaluation period, they will be granted automatic preauthorization for specific health care services, procedures, treatments, pharmaceutical products, or durable medical equipment. The insurer or health care plan must complete an initial evaluation within 180 days and implement the automatic preauthorization 225 days after the law's effective date. The approval will be valid until the insurer or health care plan provides notification of rescission, with specific conditions for how and when such rescission can occur. Health care professionals do not need to request this automatic approval, and the plan must promptly issue approvals for qualifying services. Importantly, services covered under automatic preauthorization are deemed medically necessary, and the insurer or health care plan is prohibited from retroactively denying, reducing, or recouping payment except in very limited circumstances, such as proven fraud or failure to substantially perform the service. The bill aims to streamline the preauthorization process, reduce administrative burden for health care professionals, and ensure more timely and consistent approval of medical services.

Business and Industry

https://www.nysenate.gov/legislation/bills/2025/A2352