NY State Senate Bill 2021-S6973

Senate Bill S6973

2021-2022 Legislative Session

Requires periodic reviews of pending applications for material change in the coverage status of certain matters relative to new health technology assessment or medical evidence

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Archive: Last Bill Status - In Senate Committee Health Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 05, 2022	referred to health
May 20, 2021	referred to health

co-Sponsors

2021-S6973 (ACTIVE) - Details

See Assembly Version of this Bill:: A9289
Current Committee:: Senate Health
Law Section:: Social Services Law
Laws Affected:: Amd §365-d, Soc Serv L
Versions Introduced in 2023-2024 Legislative Session:: S4787, A6022

2021-S6973 (ACTIVE) - Summary

Requires periodic reviews of pending applications for material change in the coverage status of certain matters relative to new health technology assessment or medical evidence.

2021-S6973 (ACTIVE) - Sponsor Memo

                                
 
BILL NUMBER: S6973

SPONSOR: RIVERA
 
TITLE OF BILL:

An act to amend the social services law, in relation to requiring peri-
odic reviews of pending applications for material change in the coverage
status of certain matters relative to new health technology assessment
or medical evidence

 
PURPOSE OR GENERAL IDEA OF BILL:

To ensure that the department of health considers applications for Medi-
caid coverage when there is a sufficiency of evidence to support such
coverage

 
SUMMARY OF PROVISIONS:

Section 1 amends social services law section 365-d subdivision 5 to add
a process by which providers of health technologies and services can be
assured that their applications for Medicaid coverage are reviewed by

the department of health. The amendments require the department to
publish receipt of the application, to notify the legislature when such
reviews of coverage occur and sets timeframes for review by the depart-
ment. The amendments also require the department to detail deficiencies
in such application and notify the applicant of the completeness of
application before review begins.

Section 2. Takes effect immediately

 
JUSTIFICATION:

In 2015 the Evidence Based Benefits Review Advisory Committee (EBBRAC)
was established to accept evidence from providers of services and tech-
nologies for the purpose of determining whether Medicaid should cover
such services or technologies. The department of health was authorized
to contract with a consultant to review the dossiers submitted by
provider applicants.

From 2015 through 2017 the vendor selected by the department to review
provider applications was Oregon Health Sciences. In 2017, that vendor's
contract was terminated; however, no new vendor has been selected. As
EBBRAC is the mandated body to review such applications, the lack of a
vendor to review submitted evidence has severely hampered its ability to
approve new technologies or services, and has likewise left providers of
new technologies or services no avenue to secure Medicaid coverage. As
the EBBRAC website demonstrates, it has not met since 2017.

This bill would amend the EBBRAC process to ensure that the department
maintains the ability to approve or disapprove new technologies or
services without a vendor. It also provides a meaningful and transparent
process for providers who seek to have such technology or service
covered by Medicaid.

 
PRIOR LEGISLATIVE HISTORY:

None

 
FISCAL IMPLICATIONS FOR STATE AND LOCA GOVERNMENTS:
None

 
EFFECTIVE DATE:
Immediately

2021-S6973 (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   6973
 
                        2021-2022 Regular Sessions
 
                             I N  S E N A T E
 
                               May 20, 2021
                                ___________
 
 Introduced  by  Sen.  RIVERA -- read twice and ordered printed, and when
   printed to be committed to the Committee on Health
 
 AN ACT to amend the social services law, in relation to requiring  peri-
   odic reviews of pending applications for material change in the cover-
   age  status  of  certain  matters  relative  to  new health technology
   assessment or medical evidence
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1. Subdivision 5 of section 365-d of the social services law,
 as added by section 46-a of part B of chapter 57 of the laws of 2015, is
 amended to read as follows:
   5. (A) THE COMMISSIONER, IN CONSULTATION  WITH  THE  COMMITTEE,  SHALL
 UNDERTAKE  PERIODIC  REVIEWS OF PENDING APPLICATIONS FOR MATERIAL CHANGE
 IN THE COVERAGE STATUS  OF  A  PARTICULAR  ITEM,  HEALTH  TECHNOLOGY  OR
 SERVICE,  AND ANY MATTER RELATIVE TO NEW HEALTH TECHNOLOGY ASSESSMENT OR
 MEDICAL EVIDENCE FOR WHICH AN APPLICANT HAS SUBMITTED A COMPLETE  APPLI-
 CATION  TO THE DEPARTMENT WITHIN THREE MONTHS OF RECEIPT. THE DEPARTMENT
 SHALL NOTIFY AN  APPLICANT  OF  INCOMPLETENESS  WITHIN  THIRTY  DAYS  OF
 RECEIPT OF SUBMISSION. RECEIPT OF APPLICATIONS SHALL BE PUBLISHED ON THE
 DEPARTMENT'S  WEBSITE  WITHIN  SEVEN  DAYS  OF RECEIPT. THE COMMISSIONER
 SHALL SCHEDULE A REVIEW OF SUCH PENDING APPLICATIONS AND CAUSE  PUBLICA-
 TION OF THE DATE OF REVIEW ON THE DEPARTMENT'S WEBSITE WITHIN SEVEN DAYS
 OF THE REVIEW REQUIRED BY THIS PARAGRAPH.
   (B)  THE COMMISSIONER, IN CONSULTATION WITH THE COMMITTEE, SHALL ISSUE
 A REPORT TO THE CHAIR OF THE STANDING COMMITTEE ON HEALTH IN THE  SENATE
 AND  ASSEMBLY  AND PUBLISH THE REPORT ON THE DEPARTMENT'S WEBSITE WITHIN
 THIRTY DAYS OF REVIEW OF ANY PENDING APPLICATION PURSUANT  TO  PARAGRAPH
 (A)  OF THIS SUBDIVISION. SUCH REPORT SHALL PROVIDE THE DATE OF APPLICA-
 TION, DATE OF REVIEW, AND  A  STATED  DETERMINATION  OF  SUFFICIENCY  OF
 EVIDENCE  WARRANTING  COMMITTEE  DELIBERATION AND RECOMMENDATION. IN THE
 EVENT OF AN AFFIRMATIVE DETERMINATION OF SUFFICIENCY  OF  EVIDENCE,  THE
 COMMISSIONER SHALL REQUIRE THE COMMITTEE TO ISSUE A RECOMMENDATION WITH-
 IN  SIX  MONTHS  OF SUCH DETERMINATION OF SUFFICIENCY. IN THE EVENT OF A
 NEGATIVE DETERMINATION, THE COMMISSIONER SHALL DETAIL SUCH INSUFFICIENCY

 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD11652-01-1

 S. 6973                             2
 
 OF EVIDENCE AND ALLOW THE APPLICANT  TO  CURE  STATED  DEFICIENCIES  FOR
 REVIEW UNDER THE REQUIREMENTS PROVIDED IN PARAGRAPH (A) OF THIS SUBDIVI-
 SION.
   (C) The committee shall consider any matter regarding material changes
 in  the  coverage  status  of  a  particular  item, health technology or
 service, and any matter relative to new health technology assessment  or
 medical evidence review for which the department determines a sufficient
 body  of  evidence exists to warrant committee deliberation. The commis-
 sioner shall provide members of  the  committee  with  any  evidence  or
 information  related to the health technology or medical service assess-
 ment including but not limited to, information submitted by  members  of
 the  public.  The  department shall report to the committee programmatic
 changes to benefits that do not rise to the level of a material  change,
 as  well as determinations of when sufficient medical evidence exists to
 warrant committee deliberations. The commissioner shall  provide  forty-
 five days public notice on the department's website prior to any meeting
 of the committee to develop recommendations concerning health technology
 or  medical service coverage determinations. Such notice shall include a
 description of the proposed health technology or service to be reviewed,
 the conditions or diseases impacted by the health technology or service,
 the proposals to be considered by  the  committee,  and  the  systematic
 evidence-based  assessment prepared in accordance with this subdivision.
 The committee shall allow interested parties a reasonable opportunity to
 make an oral presentation to the committee related to the  health  tech-
 nology or service to be reviewed and to submit written information.  The
 committee  shall  consider  any  information  provided by any interested
 party, including, but not limited to, health care providers, health care
 facilities, patients, consumers and manufacturers. For all health  tech-
 nologies  or  services selected for review, the department shall conduct
 or commission a systematic evidence-based assessment of the health tech-
 nology's or service's safety and clinical efficacy. The assessment shall
 use established systematic review elements,  study  quality  assessment,
 and  data  synthesis.  Upon  completion,  the systematic, evidence-based
 assessment shall be made available to the public.
   (D) THE COMMISSIONER SHALL MAKE A  DETERMINATION  OF  COVERAGE  WITHIN
 SIXTY DAYS OF THE ISSUANCE OF RECOMMENDATION BY THE COMMITTEE.
   (E) NOTWITHSTANDING ANY OTHER LAW OR REGULATION, IN THE EVENT A DETER-
 MINATION  OF  COVERAGE  STATUS IS NOT MADE UNDER THIS SECTION WITHIN ONE
 YEAR OF APPLICATION RECEIPT SUCH APPLICATION SHALL  BE  DEEMED  APPROVED
 FOR  COVERAGE  PROVIDED  SUCH  TECHNOLOGY  IS ALSO COVERED BY TWO OF THE
 FOLLOWING:
   (I) MEDICARE;
   (II) HEALTH PLANS AUTHORIZED UNDER ARTICLES THIRTY-TWO OR  FORTY-THREE
 OF THE INSURANCE LAW;
   (III) MEDICAID MANAGED CARE PLANS;
   (IV) THE BENCHMARK PLAN OF THE NEW YORK STATE OF HEALTH;
   (V) THE NEW YORK STATE HEALTH INSURANCE PLAN; OR
   (VI) THE WORKERS' COMPENSATION BOARD.
   (F)  TECHNOLOGIES  OR  SERVICES DENIED COVERAGE UNDER THIS SUBDIVISION
 MAY APPEAL SUCH DETERMINATION TO THE COMMISSIONER,  WHO  SHALL  ISSUE  A
 FINAL  DETERMINATION  OF COVERAGE WITHIN SIX MONTHS OF SUCH APPEAL. SUCH
 FINAL DETERMINATIONS SHALL BE SUBJECT TO ARTICLE  SEVENTY-EIGHT  OF  THE
 CIVIL PRACTICE LAW AND RULES.
   § 2. This act shall take effect immediately.

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Senate Bill S6973

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Sponsored By

Gustavo Rivera