Assembly Actions -
Lowercase Senate Actions - UPPERCASE |
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Feb 01, 2022 |
referred to insurance |
Senate Bill S8194
2021-2022 Legislative Session
Sponsored By
(D, WF) 46th Senate District
Archive: Last Bill Status - In Senate Committee Insurance 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
Actions
co-Sponsors
(D) Senate District
2021-S8194 (ACTIVE) - Details
- See Assembly Version of this Bill:
- A9265
- Current Committee:
- Senate Insurance
- Law Section:
- Insurance Law
- Laws Affected:
- Amd §§4902 & 4903, Ins L; amd §§4902 & 4903, Pub Health L
- Versions Introduced in 2023-2024 Legislative Session:
-
S2677, A463
2021-S8194 (ACTIVE) - Sponsor Memo
BILL NUMBER: S8194 SPONSOR: BRESLIN TITLE OF BILL: An act to amend the insurance law and the public health law, in relation to requiring notice of adverse step therapy determinations PURPOSE OR GENERAL IDEA OF BILL: The purpose of this bill is to require notice of an adverse determi- nation related to a step therapy protocol override determination request to the patient and their prescribing healthcare professional. SUMMARY OF PROVISIONS: Section one amends section 4902 of the insurance law by adding a new paragraph (14) that establishes a written procedure for the notice of an adverse determination related to a step therapy protocol override deter- mination request includes certain criteria. The bill explicitly states the request must include the reasons for the determination including the clinical rationale. In addition, it requires instructions on how to
2021-S8194 (ACTIVE) - Bill Text download pdf
S T A T E O F N E W Y O R K ________________________________________________________________________ 8194 I N S E N A T E February 1, 2022 ___________ Introduced by Sen. BRESLIN -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance AN ACT to amend the insurance law and the public health law, in relation to requiring notice of adverse step therapy determinations THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Subsection (a) of section 4902 of the insurance law is amended by adding a new paragraph 14 to read as follows: (14) ESTABLISHMENT OF A WRITTEN PROCEDURE TO ASSURE THAT THE NOTICE OF AN ADVERSE DETERMINATION IN RELATION TO A STEP THERAPY PROTOCOL OVERRIDE DETERMINATION REQUEST INCLUDES: (I) THE REASONS FOR THE DETERMINATION INCLUDING THE CLINICAL RATION- ALE, IF ANY; (II) INSTRUCTIONS ON HOW TO INITIATE STANDARD AND EXPEDITED APPEALS PURSUANT TO SECTION FOUR THOUSAND NINE HUNDRED FOUR OF THIS ARTICLE AND AN EXTERNAL APPEAL PURSUANT TO SECTION FOUR THOUSAND NINE HUNDRED FOUR- TEEN OF THIS ARTICLE; (III) INFORMATION THAT INCLUDES: ANY APPLICABLE ALTERNATIVE COVERED MEDICATIONS; THE CLINICAL REVIEW CRITERIA RELIED UPON TO MAKE SUCH DETERMINATION; AND ANY ADDITIONAL NECESSARY INFORMATION THAT MUST BE PROVIDED TO, OR OBTAINED BY, THE UTILIZATION REVIEW AGENT IN ORDER TO RENDER A DECISION ON THE APPEAL. § 2. Section 4903 of the insurance law is amended by adding a new subsection (e-1) to read as follows: (E-1) NOTICE OF AN ADVERSE DETERMINATION MADE BY A UTILIZATION REVIEW AGENT IN RELATION TO A STEP THERAPY PROTOCOL OVERRIDE DETERMINATION REQUEST SHALL BE MADE IN WRITING TO THE INSURED OR THE INSURED'S AUTHOR- IZED REPRESENTATIVE AND THE INSURED'S PRESCRIBING HEALTH CARE PROFES- SIONAL AS DEFINED IN SUBSECTION (F) OF SECTION FORTY-NINE HUNDRED OF THIS CHAPTER, AND SHALL INCLUDE: (I) THE REASONS FOR THE DETERMINATION INCLUDING THE CLINICAL RATION- ALE, IF ANY; (II) INSTRUCTIONS ON HOW TO INITIATE STANDARD AND EXPEDITED APPEALS PURSUANT TO SECTION FOUR THOUSAND NINE HUNDRED FOUR OF THIS ARTICLE AND EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted.
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