NY State Senate Bill 2025-S1225

Senate Bill S1225

2025-2026 Legislative Session

Requires periodic reviews of pending applications for material change in the coverage status of certain matters relative to new health technology assessment or medical evidence

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Current Bill Status - In Senate Committee Health 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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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 08, 2025	referred to health

co-Sponsors

2025-S1225 (ACTIVE) - Details

Current Committee:: Senate Health
Law Section:: Social Services Law
Laws Affected:: Amd §365-d, Soc Serv L
Versions Introduced in Other Legislative Sessions:: 2021-2022: S6973
2023-2024: S4787

2025-S1225 (ACTIVE) - Summary

Requires periodic reviews of pending applications for material change in the coverage status of certain matters relative to new health technology assessment or medical evidence.

2025-S1225 (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S1225

SPONSOR: RIVERA
 
TITLE OF BILL:

An act to amend the social services law, in relation to requiring peri-
odic reviews of pending applications for material change in the coverage
status of certain matters relative to new health technology assessment
or medical evidence

 
PURPOSE:

Requires periodic reviews of pending applications for material change in
the coverage status of certain matters relative to new health technology
assessment or medical evidence.

 
SUMMARY OF SPECIFIC PROVISIONS:

Section 1 amends subdivision 5 of section 365-d of the social services
law as it relates to the Medicaid evidence based benefit review advisory
committee, and outlines their review and reporting requirements that the
Commissioner of Health, in consultation with the committee, would under-

take when reviewing pending applications for material change in the
coverage status of a particular item, health technology assessment or
services, and anything relative to new health technology assessments.

Section 2 provides the effective date

 
JUSTIFICATION:

In 2015, the Evidence Based Benefits Review Advisory Committee (EBBRAC)
was established to accept evidence from providers of services and tech-
nologies for the purpose of determining whether Medicaid should cover
such services or technologies. The Department of Health (DOH) was
authorized to contract with a consultant to review the dossiers submit-
ted by provider applicants.

From 2015 through 2017, the vendor selected by the DOH to review provid-
er applications was Oregon Health Sciences. In 2017, that vendor's
contract was terminated; however, no new vendor has been selected. As
EBBRAC is the mandated body to review such applications, the lack of a
vendor to review submitted evidence has severely hampered its ability to
approve new technologies or services and has likewise left providers of
new technologies or services without an avenue to secure Medicaid cover-
age. As EBBRAC's website shows, it has not met since 2017.

This bill would amend the EBBRAC process to ensure that the DOH main-
tains the ability to approve or disapprove new technologies or services
without a vendor. It also provides a meaningful and transparent process
for providers who seek to have such technology or service covered by
Medicaid.

 
LEGISLATIVE HISTORY:

2021-2022: S6973 Rivera / A9289 Gottfried

2023-2024: S4787-A Rivera I A6022-A Paulin - Vetoed Memo. 31

 
FISCAL IMPLICATIONS:
None.

 
EFFECTIVE DATE:
This act shall take effect immediately.

2025-S1225 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1225
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                              January 8, 2025
                                ___________
 
 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
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD03478-01-5

 S. 1225                             2
 
 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
 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.
   § 2. This act shall take effect immediately.

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Senate Bill S1225

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Sponsored By

Gustavo Rivera