S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   4787
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                             February 14, 2023
                                ___________
 
 Introduced by Sens. RIVERA, RAMOS -- 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.
                                                            LBD08099-01-3
 S. 4787                             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.