Assembly Bill A7268A

2023-2024 Legislative Session

Relates to utilization review program standards and pre-authorization for certain health care services

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Sponsored By

Current Bill Status - In Assembly 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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Bill Amendments

co-Sponsors

2023-A7268 - Details

See Senate Version of this Bill:
S3400
Current Committee:
Assembly Rules
Law Section:
Public Health Law
Laws Affected:
Amd §§4902 & 4903, Pub Health L; amd §§4902 & 4903, Ins L
Versions Introduced in Other Legislative Sessions:
2017-2018: A9588, S7872
2019-2020: A3038, S2847
2021-2022: A7129, S6435

2023-A7268 - Summary

Relates to utilization review program standards; requires use of evidence-based and peer reviewed clinical review criteria; relates to prescription drug formulary changes and pre-authorization for certain health care services.

2023-A7268 - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7268
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                               May 16, 2023
                                ___________
 
 Introduced  by  M.  of A. WEPRIN, WOERNER, TAYLOR, SANTABARBARA, COLTON,
   LUPARDO, STIRPE, EPSTEIN, PAULIN, NORRIS,  SEAWRIGHT,  SIMON,  JOYNER,
   LAVINE, STECK, TANNOUSIS, WALLACE, GUNTHER, L. ROSENTHAL, MEEKS, DAVI-
   LA,  WILLIAMS,  SILLITTI -- read once and referred to the Committee on
   Insurance

 AN ACT to amend the public health law and the insurance law, in relation
   to utilization review program standards, and in  relation  to  pre-au-
   thorization of health care services
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1.  Paragraph (c) of subdivision 1  of  section  4902  of  the
 public  health  law,  as  added  by  chapter 705 of the laws of 1996, is
 amended to read as follows:
   (c) Utilization of written clinical review criteria developed pursuant
 to a utilization  review  plan.  SUCH  CLINICAL  REVIEW  CRITERIA  SHALL
 UTILIZE  RECOGNIZED  EVIDENCE-BASED  AND  PEER  REVIEWED CLINICAL REVIEW
 CRITERIA THAT TAKE INTO ACCOUNT THE NEEDS OF  A  TYPICAL  PATIENT  POPU-
 LATIONS AND DIAGNOSES;
   §  2.  Paragraph  (a)  of  subdivision 2 of section 4903 of the public
 health law, as separately amended by section 13 of part YY and section 3
 of part KKK of chapter 56 of the laws of 2020, is  amended  to  read  as
 follows:
   (a)  A utilization review agent shall make a utilization review deter-
 mination involving health care services which require  pre-authorization
 and  provide  notice  of  a  determination to the enrollee or enrollee's
 designee and the enrollee's health care provider  by  telephone  and  in
 writing within [three business days] SEVENTY-TWO HOURS of receipt of the
 necessary information, WITHIN TWENTY-FOUR HOURS OF THE RECEIPT OF NECES-
 SARY INFORMATION IF THE REQUEST IS FOR AN ENROLLEE WITH A MEDICAL CONDI-
 TION  THAT  PLACES THE HEALTH OF THE INSURED IN SERIOUS JEOPARDY WITHOUT
 THE HEALTH CARE SERVICES  RECOMMENDED  BY  THE  ENROLLEE'S  HEALTH  CARE
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD08333-01-3
              

co-Sponsors

2023-A7268A (ACTIVE) - Details

See Senate Version of this Bill:
S3400
Current Committee:
Assembly Rules
Law Section:
Public Health Law
Laws Affected:
Amd §§4902 & 4903, Pub Health L; amd §§4902 & 4903, Ins L
Versions Introduced in Other Legislative Sessions:
2017-2018: A9588, S7872
2019-2020: A3038, S2847
2021-2022: A7129, S6435

2023-A7268A (ACTIVE) - Summary

Relates to utilization review program standards; requires use of evidence-based and peer reviewed clinical review criteria; relates to prescription drug formulary changes and pre-authorization for certain health care services.

2023-A7268A (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  7268--A
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                               May 16, 2023
                                ___________
 
 Introduced  by  M.  of A. WEPRIN, WOERNER, TAYLOR, SANTABARBARA, COLTON,
   LUPARDO, STIRPE, EPSTEIN, PAULIN, NORRIS,  SEAWRIGHT,  SIMON,  LAVINE,
   STECK,  TANNOUSIS,  WALLACE,  GUNTHER,  L. ROSENTHAL,  MEEKS,  DAVILA,
   WILLIAMS,  SILLITTI,  ARDILA,  LUNSFORD,  BORES,  PIROZZOLO,   KELLES,
   CARROLL, SIMPSON, BENDETT, REYES, ANGELINO, SAYEGH, THIELE, LEVENBERG,
   SOLAGES,  RAMOS,  DiPIETRO, GALLAHAN, RAGA, HEVESI, CLARK, SHRESTHA --
   read once and referred to the Committee on Insurance -- recommitted to
   the Committee on Insurance in accordance with Assembly Rule 3, sec.  2
   --  committee  discharged,  bill amended, ordered reprinted as amended
   and recommitted to said committee
 
 AN ACT to amend the public health law and the insurance law, in relation
   to utilization  review  program  standards  and  pre-authorization  of
   health care services
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1.  Paragraph (c) of subdivision 1  of  section  4902  of  the
 public  health  law,  as  added  by  chapter 705 of the laws of 1996, is
 amended to read as follows:
   (c) Utilization of written clinical review criteria developed pursuant
 to a utilization  review  plan.  SUCH  CLINICAL  REVIEW  CRITERIA  SHALL
 UTILIZE  RECOGNIZED  EVIDENCE-BASED  AND  PEER  REVIEWED CLINICAL REVIEW
 CRITERIA THAT TAKE INTO ACCOUNT THE NEEDS OF  A  TYPICAL  PATIENT  POPU-
 LATIONS AND DIAGNOSES;
   §  2.  Paragraph  (a)  of  subdivision 2 of section 4903 of the public
 health law, as separately amended by section 13 of part YY and section 3
 of part KKK of chapter 56 of the laws of 2020, is  amended  to  read  as
 follows:
   (a)  A utilization review agent shall make a utilization review deter-
 mination involving health care services which require  pre-authorization
 and  provide  notice  of  a  determination to the enrollee or enrollee's
 designee and the enrollee's health care provider  by  telephone  and  in

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD08333-02-4
              

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