Requires insurers and health plans to grant automatic preauthorization approvals to eligible health care professionals in certain circumstances.
Summary
This bill would amend the Insurance Law and Public Health Law to create an “automatic preauthorization approval” system for certain health care professionals and services. If an insurer or health care plan has approved at least 90% of a provider’s prior preauthorization requests for a particular service during the most recent six-month evaluation period, the provider would automatically qualify for preauthorization approval for that service going forward, subject to annual review and specified rescission procedures. The bill applies to a broad range of services, including procedures, treatments, pharmaceuticals, and durable medical equipment.
The bill also sets out detailed notice, appeal, and documentation requirements. Insurers and health plans would have to notify providers when they qualify, issue automatic approvals promptly when requests are submitted for covered services, and provide data and explanations if they seek to deny or rescind the approval. The measure limits when approvals can be rescinded, requires advance notice and an opportunity to appeal, and directs the superintendent and commissioner to promulgate implementing regulations.
Impact
The bill would significantly alter utilization review and payment practices under New York’s insurance and public health laws by creating a presumption of approval for providers with consistently high preauthorization approval rates. It would reduce prior authorization burdens for qualifying providers, require faster approvals, and restrict insurers’ ability to later deny, reduce, or recoup payment for services covered by an automatic approval, except in cases such as material misrepresentation or failure to substantially perform the service. It also preserves insurers’ ability to conduct retrospective review, but limits the financial consequences of that review for services covered by automatic approval.
Sentiment
No committee transcripts or recorded votes were provided, so there is no documented legislative debate or voting history to gauge support or opposition. Based on the bill text alone, the measure appears designed to address provider frustration with prior authorization delays and administrative burden, suggesting a pro-provider and pro-patient-access policy rationale. The absence of recorded discussion means the overall sentiment in the available record is neutral and untested.
Contention
The main points of contention likely involve the balance between reducing administrative friction for providers and preserving insurer oversight of medical necessity and cost control. Insurers and health plans may object to the 90% threshold, the automatic nature of approvals, and the restrictions on retroactive denials and recoupments, arguing these provisions could weaken utilization management and increase costs. Providers and patient advocates would likely support the bill because it rewards providers with strong approval histories, speeds access to care, and limits repeated prior authorization requirements. The bill’s detailed data-disclosure and regulatory requirements may also be a point of dispute because they increase compliance obligations for plans.
Enacts the "health insurance preauthorization disclosure act"; requires health insurance companies to provide participating health care providers with a list of health care treatments and services that require preauthorization from the health insurance company.
A bill for an act relating to subacute mental health care facilities and services, and including effective date provisions. (Formerly HF 2220.) Effective date: 05/02/2026.