Senate Bill S8194

2021-2022 Legislative Session

Requires notice of adverse step therapy determinations

download bill text pdf

Sponsored By

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

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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) - Summary

Requires written notice of an adverse determination made by a utilization review agent in relation to a step therapy protocol override determination.

2021-S8194 (ACTIVE) - Sponsor Memo

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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