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Governor Signs Managed Care Bill; Acts on Other Health Bills

Governor David Paterson today signed into law the managed care market conduct reform package that represents significant progress toward bringing accountability to managed care organizations and enhancing consumer and provider protections.

The law is a consensus-driven package, resulting from extensive negotiations by HANYS, Northern Metropolitan Hospital Association, Nassau-Suffolk Hospital Council, and the other allied associations with the State Insurance Department, Department of Health, Medical Society of the State of New York, Home Care Association of New York State, and health insurance plans. Key provisions of the law include:

  • create an explicit provider right to an external appeal of a claim denial;
  • reduce payment timeframes for electronically submitted claims to 30 days;
  • limit a plan’s ability to deny certain claims on the basis of coordination of benefits with another insurer that is liable for payment, and limit a plan’s ability to deny payment for untimely filing of a claim;
  • prohibit payers from changing the status of an in-network provider to out-of-network based on the status of a treating provider;
  • provide limitations and greater due process protection for all providers from overpayment recovery efforts by health plans; and
  • enhance discharge planning by requiring tighter utilization review timeframes for post-hospital services.

“This landmark law has been a multi-year effort by HANYS and allied associations to bring greater accountability to managed care organizations, and address a long list of concerns that our members have had about enhancing consumer and provider protections,” commented HANYS’ President Daniel Sisto. “Consumers and employers will benefit from these measures by getting greater value for their premium dollars, and providers move a significant step closer to achieving a more level playing field in the marketplace. We are grateful to Governor Paterson and the Legislature for approving this much-needed reform.”

HANYS will host regional briefings in September and October to educate members on the managed care reform package, the coordination of benefits regulation that became effective on July 15, and the prior authorization law that became law in 2007, all of which HANYS played a major role in negotiating and strongly supported.

While at the University at Rochester Medical Center today, Governor Paterson also signed legislation that mandates group health insurance policies covering dependents to provide coverage to unmarried “children” up to age 29, regardless of student status or actual dependence, as long as the child is not provided coverage as a named insured under another group policy. This program bill is geared to make insurance more affordable for the “young invincibles” (ages 19-29) who comprise the largest share of the uninsured.

In addition, the governor signed a bill that extends the Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage period from 18 to 36 months. This will ensure that employees who are layed off can continue to receive benefits longer. Contact: Jeffrey Gold

Published July 29, 2009