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Governor Signs Law Expanding Dependent Coverage Options, Other Managed Care Reforms

On July 29 Governor Paterson announced that he signed Assembly 9038/Senate 6030 into law, which extends the coverage option for unmarried dependent children of policyholders from the current 19 years of age (or 21 for full-time students) to 29 years of age. The law will apply to commercially insured products issued or renewed after September 1, 2009. The law will not apply to self-insured employer plans or government plans.

The bill was part of a small package of health reform laws, summarized in the Governor's press release as follows:

The first extends the period of time for COBRA coverage from 18 to 36 months; the second permits families to cover their young adult dependents through age 29 under their job-based insurance; and the third enacts a series of managed care reforms to make health insurance work better for consumers and permit timely access to necessary health services.

Read the governor's press release here.

The managed care reform bill is described in the press release as:

  • Prohibiting insurers from treating an in-network provider as out-of-network simply because the referring provider was out-of-network;

  • Extending current protections for consumers in HMOs to consumers in “HMO look-alike” plans – health plans that operate the same as HMOs but are not licensed as HMOs, such as “exclusive provider organizations” or EPOs;

  • Reducing the prompt-pay timeframe from 45 days to 30 days for electronically submitted claims so doctors and hospitals are paid more quickly;

  • Reducing the time insurers have to review requests for post-hospital home health care;

  • Extending providers a right to request an external appeal of a concurrent denial;

  • Extending protections to doctors and hospitals when health insurers seek to recover alleged overpayments. The protections include basic notice and an opportunity to challenge the insurers’ overpayment recovery efforts.

  • Limiting health insurers’ and HMOs’ ability to deny or delay payment of claims by sending a coordination of benefits questionnaire;

  • Permitting participating health care providers to request reconsideration of a claim that is denied as untimely and limiting penalties for untimely claims;

  • Requiring insurers and HMOs to give participating providers notice of adverse reimbursement changes to provider contracts and giving providers an opportunity to cancel the contract;

  • Requiring insurers and HMOs who fail to meet a loss-ratio requirement to make efforts to locate and pay dividends or credits to former policy holders;

  • Permitting newly licensed providers and providers moving to New York to be provisionally credentialed until the final determination is made; and

  • Establishing a new external appeal standard for rare disease treatments.

The managed care reform bill is Assembly 8402-A/Senate 5472-A.

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This page contains a single entry from the blog posted on July 30, 2009 12:12 PM.

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