NY State Senate Bill 2023-S2677A

Current Bill Status Via A463 - Signed by Governor

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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Actions

View Actions

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Dec 22, 2023	approval memo.61 signed chap.735
Dec 12, 2023	delivered to governor
Jun 07, 2023	returned to assembly passed senate 3rd reading cal.1179 substituted for s2677a
Jun 07, 2023	substituted by a463a
May 30, 2023	amended on third reading 2677a
May 24, 2023	advanced to third reading
May 23, 2023	2nd report cal.
May 22, 2023	1st report cal.1179
Jan 24, 2023	referred to insurance

Votes

- Jun 7, 2023 - Floor Vote
  A463
  
  61
  
  Aye
  
  0
  
  Nay
  
  0
  
  Absent
  
  2
  
  Excused
  
  0
  
  Abstained
  - - Floor Vote: Jun 7, 2023
      
      aye (61)
      
      Addabbo Jr.
      
      Ashby
      
      Bailey
      
      Borrello
      
      Breslin
      
      Brisport
      
      Brouk
      
      Canzoneri-Fitzpatrick
      
      Chu
      
      Cleare
      
      Comrie
      
      Fernandez
      
      Gallivan
      
      Gianaris
      
      Gonzalez
      
      Gounardes
      
      Griffo
      
      Harckham
      
      Helming
      
      Hinchey
      
      Hoylman-Sigal
      
      Jackson
      
      Kavanagh
      
      Kennedy
      
      Krueger
      
      Lanza
      
      Liu
      
      Mannion
      
      Martinez
      
      Martins
      
      Mattera
      
      May
      
      Mayer
      
      Murray
      
      Myrie
      
      O'Mara
      
      Oberacker
      
      Ortt
      
      Palumbo
      
      Parker
      
      Persaud
      
      Ramos
      
      Rhoads
      
      Rivera
      
      Rolison
      
      Ryan
      
      Salazar
      
      Sanders Jr.
      
      Scarcella-Spanton
      
      Sepúlveda
      
      Serrano
      
      Skoufis
      
      Stavisky
      
      Stec
      
      Stewart-Cousins
      
      Tedisco
      
      Thomas
      
      Walczyk
      
      Webb
      
      Weber
      
      Weik
      
      excused (2)
      
      Cooney
      
      Felder
  May 22, 2023 - Insurance Committee Vote
  S2677A
  
  10
  
  Aye
  
  0
  
  Nay
  
  1
  
  Aye with Reservations
  
  0
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  - - Insurance Committee Vote: May 22, 2023
      
      aye (10)
      
      Addabbo Jr.
      
      Borrello
      
      Breslin
      
      Cooney
      
      Harckham
      
      Kennedy
      
      Martinez
      
      O'Mara
      
      Sanders Jr.
      
      Scarcella-Spanton
      
      aye wr (1)
      
      Helming

Bill Amendments

Original

A (Active)

co-Sponsors

2023-S2677 - Details

See Assembly Version of this Bill:: A463
Law Section:: Insurance Law
Laws Affected:: Amd §§4902 & 4903, Ins L; amd §§4902 & 4903, Pub Health L
Versions Introduced in 2021-2022 Legislative Session:: S8194, A9265

2023-S2677 - Summary

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

2023-S2677 - Sponsor Memo

                                 
BILL NUMBER: S2677

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

initiate standard and expedited appeals.  Finally, it requires infor-
maion that includes any applicable alternative covered, the clinical
review criteria relied upon, and any additional necessary information
the utilization review agent relied upon to render such decision.

Section two amends section 4903 of the insurance law to require the
aforementioned notice of an adverse determination made by a utilization
review agent related to a step therapy protocol override determination
request. Such notice is required to be made in writing to the insured or
their agent and their prescribing healthcare professional. The notice
must include the written procedure as required in section one.

Section three amends section 4902 of the public health law with the same
required written procedure guidelines as section one.

Section four amends section 4903 of the public health law with the same
notice requirements for enrollees as section two.

Section five establishes the effective date, 90 days after it shall
become law.

 
JUSTIFICATION:

Providing information on step therapy protocols allows patients to make
informed decisions when selecting a health plan. It also allows patients
and health care professionals to more easily request step therapy over-
rides and appeals and plan for efficient treatment.

 
PRIOR LEGISLATIVE HISTORY:

S8194 - 2021/22

 
FISCAL IMPLICATIONS:

None

 
EFFECTIVE DATE:
This act shall take effect on the ninetieth day after it shall become
law. Effective immediately, the addition, amendment and/or repeal of any
rule or regulation necessary for the implementation of this act on its
effective date are authorized to be made and completed on or before such
effective date.

2023-S2677 - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   2677
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                             January 24, 2023
                                ___________
 
 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:
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD02500-01-3
 S. 2677                             2

 
   (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.
   § 3. Subdivision 1 of section 4902 of the public health law is amended
 by adding a new paragraph (l) to read as follows:
   (L) 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 RATIONALE, IF ANY; (II) INSTRUCTIONS  ON  HOW  TO
 INITIATE  STANDARD  AND EXPEDITED APPEALS PURSUANT TO SUBDIVISION TWO OF
 SECTION FORTY-NINE HUNDRED FOUR OF THIS TITLE  AND  AN  EXTERNAL  APPEAL
 PURSUANT  TO  SECTION FORTY-NINE HUNDRED FOURTEEN OF THIS ARTICLE; (III)
 INFORMATION THAT INCLUDES: ANY APPLICABLE  ALTERNATIVE  COVERED  MEDICA-
 TIONS;  THE  CLINICAL  REVIEW CRITERIA RELIED UPON TO MAKE SUCH DETERMI-
 NATION; 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.
   § 4. Section 4903 of the public health law is amended by adding a  new
 subdivision 5-a to read as follows:
   5-A.  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 ENROLLEE OR THE ENROLLEE'S
 AUTHORIZED REPRESENTATIVE AND THE  ENROLLEE'S  PRESCRIBING  HEALTH  CARE
 PROFESSIONAL AS DEFINED IN SUBDIVISION SIX OF SECTION FORTY-NINE HUNDRED
 OF THIS TITLE, AND SHALL INCLUDE:
   (A)  THE  REASONS FOR THE DETERMINATION INCLUDING THE CLINICAL RATION-
 ALE, IF ANY;
   (B) INSTRUCTIONS ON HOW TO INITIATE  STANDARD  AND  EXPEDITED  APPEALS
 PURSUANT  TO  SECTION  FORTY-NINE  HUNDRED  FOUR  OF  THIS  TITLE AND AN
 EXTERNAL APPEAL PURSUANT TO SECTION FORTY-NINE HUNDRED FOURTEEN OF  THIS
 ARTICLE;
   (C)  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.
   §  5.  This  act shall take effect on the ninetieth day after it shall
 have become a law. Effective immediately, the addition, amendment and/or
 repeal of any rule or regulation necessary  for  the  implementation  of
 this  act  on its effective date are authorized to be made and completed
 on or before such effective date.

co-Sponsors

2023-S2677A (ACTIVE) - Details

See Assembly Version of this Bill:: A463
Law Section:: Insurance Law
Laws Affected:: Amd §§4902 & 4903, Ins L; amd §§4902 & 4903, Pub Health L
Versions Introduced in 2021-2022 Legislative Session:: S8194, A9265

2023-S2677A (ACTIVE) - Summary

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

2023-S2677A (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S2677A

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

initiate standard and expedited appeals.  Finally, it requires informa-
tion that includes any applicable alternative covered, the clinical
review criteria relied upon, and any additional necessary information
the utilization review agent relied upon to render such decision.

Section two amends section 4903 of the insurance law to require the
aforementioned notice of an adverse determination made by a utilization
review agent related to a step therapy protocol override determination
request. Such notice is required to be made in writing to the insured or
their agent and their prescribing healthcare professional. The notice
must include the written procedure as required in section one.

The provisions of this section shall be satisfied by making such infor-
mation available electronically on a formulary website, on the member
portal and/or provider portal of the insurer, health maintenance organ-
izations, or article forty-three organizations website, provided that
the member consents to receiving the information electronically.

Section three amends section 4902 of the public health law with the same
required written procedure guidelines as section one.

Section four amends section 4903 of the public health law with the same
notice requirements for enrollees as section two.

Section five establishes the effective date, 90 days after it shall
become law.

 
JUSTIFICATION:

Providing information on step therapy protocols allows patients to make
informed decisions when selecting a health plan. It also allows patients
and health care professionals to more easily request step therapy over-
rides and appeals and plan for efficient treatment.

 
PRIOR LEGISLATIVE HISTORY:

S8194 - 2021/22
 
FISCAL IMPLICATIONS:

None

 
EFFECTIVE DATE:
This act shall take effect on the ninetieth day after it shall become
law. Effective immediately, the addition, amendment and/or repeal of any
rule or regulation necessary for the implementation of this act on its
effective date are authorized to be made and completed on or before such
effective date.

2023-S2677A (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  2677--A
     Cal. No. 1179
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                             January 24, 2023
                                ___________
 
 Introduced  by  Sens.  BRESLIN, HOYLMAN-SIGAL, SKOUFIS -- read twice and
   ordered printed, and when printed to be committed to the Committee  on
   Insurance  -- reported favorably from said committee, ordered to first
   and second report, ordered to a third  reading,  amended  and  ordered
   reprinted, retaining its place in the order of third reading
 
 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;
   (IV)  THE PROVISIONS OF THIS SECTION SHALL BE SATISFIED BY MAKING SUCH
 INFORMATION AVAILABLE ELECTRONICALLY ON  A  FORMULARY  WEBSITE,  ON  THE
 MEMBER  PORTAL AND/OR PROVIDER PORTAL OF THE INSURER'S, THE HEALTH MAIN-
 TENANCE ORGANIZATION'S  WEBSITE,  OR  THE  WEBSITE  OF  AN  ORGANIZATION
 SUBJECT TO ARTICLE FORTY-THREE OF THIS CHAPTER, PROVIDED THAT THE MEMBER
 CONSENTS TO RECEIVING THE INFORMATION ELECTRONICALLY.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD02500-02-3
 S. 2677--A                          2
 
   §  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
 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;
   (IV)  THE PROVISIONS OF THIS SECTION SHALL BE SATISFIED BY MAKING SUCH
 INFORMATION AVAILABLE ELECTRONICALLY ON  A  FORMULARY  WEBSITE,  ON  THE
 MEMBER  PORTAL AND/OR PROVIDER PORTAL OF THE INSURER'S, THE HEALTH MAIN-
 TENANCE ORGANIZATION'S  WEBSITE,  OR  THE  WEBSITE  OF  AN  ORGANIZATION
 SUBJECT TO ARTICLE FORTY-THREE OF THIS CHAPTER, PROVIDED THAT THE MEMBER
 CONSENTS TO RECEIVING THE INFORMATION ELECTRONICALLY.
   § 3. Subdivision 1 of section 4902 of the public health law is amended
 by adding a new paragraph (l) to read as follows:
   (L)  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  RATIONALE, IF ANY; (II) INSTRUCTIONS ON HOW TO
 INITIATE STANDARD AND EXPEDITED APPEALS PURSUANT TO SUBDIVISION  TWO  OF
 SECTION  FORTY-NINE  HUNDRED  FOUR  OF THIS TITLE AND AN EXTERNAL APPEAL
 PURSUANT TO SECTION FORTY-NINE HUNDRED FOURTEEN OF THIS  ARTICLE;  (III)
 INFORMATION  THAT  INCLUDES:  ANY APPLICABLE ALTERNATIVE COVERED MEDICA-
 TIONS; THE CLINICAL REVIEW CRITERIA RELIED UPON TO  MAKE  SUCH  DETERMI-
 NATION;  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;  (IV) THE PROVISIONS OF THIS SECTION SHALL BE
 SATISFIED BY MAKING  SUCH  INFORMATION  AVAILABLE  ELECTRONICALLY  ON  A
 FORMULARY  WEBSITE,  ON  THE MEMBER PORTAL AND/OR PROVIDER PORTAL OF THE
 INSURER'S, THE HEALTH MAINTENANCE ORGANIZATION'S WEBSITE, OR THE WEBSITE
 OF AN ORGANIZATION SUBJECT  TO  ARTICLE  FORTY-THREE  OF  THIS  CHAPTER,
 PROVIDED THAT THE MEMBER CONSENTS TO RECEIVING THE INFORMATION ELECTRON-
 ICALLY.
   §  4. Section 4903 of the public health law is amended by adding a new
 subdivision 5-a to read as follows:
   5-A. 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  ENROLLEE  OR  THE  ENROLLEE'S
 AUTHORIZED  REPRESENTATIVE  AND  THE  ENROLLEE'S PRESCRIBING HEALTH CARE
 PROFESSIONAL AS DEFINED IN SUBDIVISION SIX OF SECTION FORTY-NINE HUNDRED
 OF THIS TITLE, AND SHALL INCLUDE:
   (A) THE REASONS FOR THE DETERMINATION INCLUDING THE  CLINICAL  RATION-
 ALE, IF ANY;
 S. 2677--A                          3
 
   (B)  INSTRUCTIONS  ON  HOW  TO INITIATE STANDARD AND EXPEDITED APPEALS
 PURSUANT TO SECTION  FORTY-NINE  HUNDRED  FOUR  OF  THIS  TITLE  AND  AN
 EXTERNAL  APPEAL PURSUANT TO SECTION FORTY-NINE HUNDRED FOURTEEN OF THIS
 ARTICLE;
   (C)  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;
   (D)  THE  PROVISIONS OF THIS SECTION SHALL BE SATISFIED BY MAKING SUCH
 INFORMATION AVAILABLE ELECTRONICALLY ON  A  FORMULARY  WEBSITE,  ON  THE
 MEMBER  PORTAL AND/OR PROVIDER PORTAL OF THE INSURER'S, THE HEALTH MAIN-
 TENANCE ORGANIZATION'S  WEBSITE,  OR  THE  WEBSITE  OF  AN  ORGANIZATION
 SUBJECT TO ARTICLE FORTY-THREE OF THIS CHAPTER, PROVIDED THAT THE MEMBER
 CONSENTS TO RECEIVING THE INFORMATION ELECTRONICALLY.
   §  5.  This  act shall take effect on the ninetieth day after it shall
 have become a law. Effective immediately, the addition, amendment and/or
 repeal of any rule or regulation necessary  for  the  implementation  of
 this  act  on its effective date are authorized to be made and completed
 on or before such effective date.

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Senate Bill S2677A

Sponsored By

Current Bill Status Via A463 - Signed by Governor

Jun 7, 2023 - Floor Vote

Floor Vote: Jun 7, 2023

May 22, 2023 - Insurance Committee Vote

Insurance Committee Vote: May 22, 2023

Bill Amendments

co-Sponsors

2023-S2677 - Details

2023-S2677 - Summary

2023-S2677 - Sponsor Memo

2023-S2677 - Bill Text download pdf

co-Sponsors

2023-S2677A (ACTIVE) - Details

2023-S2677A (ACTIVE) - Summary

2023-S2677A (ACTIVE) - Sponsor Memo

2023-S2677A (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S2677A

Share this bill

Sponsored By

Neil D. Breslin

Current Bill Status Via A463 - Signed by Governor

Bill Amendments

co-Sponsors

Brad Hoylman-Sigal

James Skoufis

2023-S2677 - Details

2023-S2677 - Summary

2023-S2677 - Sponsor Memo

2023-S2677 - Bill Text download pdf

co-Sponsors

Brad Hoylman-Sigal

James Skoufis

2023-S2677A (ACTIVE) - Details

2023-S2677A (ACTIVE) - Summary

2023-S2677A (ACTIVE) - Sponsor Memo

2023-S2677A (ACTIVE) - Bill Text download pdf

Comments