Q44A express service increased ridership on the route by 15%. In April 1974, an extension of the Q44A to Long Island Jewish Hospital was approved, which made it the first city route to extend into Nassau County. The extension was approved by Queens Borough President Donald Manes and Nassau County Executive Ralph Caso, and it was first proposed by the Lost Community Civic Association of Floral Park. The extension faced legal hurdles–the NYCTA did not authorize it to operate any franchised service outside city limits. However, in 1968, with the passage of the Metropolitan Transportation Authority Act, the NYCTA became subordinate to the MTA, which could determine transit plans and policies for the NYCTA. The head of the MTA, William Ronan, searched for a legal mechanism to allow for the extension. The decided course of action included a request for the service by the Queens Borough President and approval by the Nassau County Executive, an approval or no objection by the New York City Comptroller and approval by the Mayor. When the Queens Village depot was opened on September 8, 1974, the Q44A was reassigned from Flushing Depot (the former North Shore Bus Company facility). Around this time, there was a third branch in Little Neck, separate from the Glen Oaks branch. This branch diverged north at Commonwealth Boulevard, running along Commonwealth and the Grand Central Parkway service road and terminating at Little Neck Parkway. The Q44A was renumbered to the Q46 on April 12, 1990. The Q46 was extended from Lakeville Road to Long Island Jewish Hospital on September 7, 1997, saving a half-mile walk. On November 17, 1997, limited-stop buses started to make an additional stop at 150th Street. Overnight and weekend service to Glen Oaks was eliminated on September 8, 2002. The operation of reverse-peak limited-stop service in the morning rush hour was approved by the MTA Board in October 2005. On February 2, 2008, the LIJ branch's terminal was moved to Lakeville Road outside the hospital gates due to construction within the hospital grounds, particularly a new women's hospital adjacent to the bus stop. The Katz Women's Hospital was completed in December 2011, and the Q46 began running to a new terminal within the hospital. The Northeast Queens Bus Study was released in 2015, and recommended, for the long term, the implementation of a pilot program for limited-zone bus service on one or more routes in Northeast Queens including the Q46. The study also recommended the implementation of Select Bus Service along Union Turnpike.