senate Bill S132

Authorizes a pilot program for enhanced prior approval of high cost diagnostic radiology services

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Bill Status


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor
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actions

  • 09 / Jan / 2013
    • REFERRED TO HEALTH
  • 08 / Jan / 2014
    • REFERRED TO HEALTH

Summary

Authorizes the commissioner of health, within fiscal year 2013-2014, to contract with high bidders to perform pilot projects to assess the feasibility of reducing medically unnecessary high cost radiological procedures and generalizing cost savings to the state through enhanced medical management and prior review of orders for diagnostic imaging.

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Bill Details

Versions:
S132
Legislative Cycle:
2013-2014
Current Committee:
Senate Health
Law Section:
Social Services Law
Laws Affected:
Add ยง369-gg, Soc Serv L
Versions Introduced in Previous Legislative Cycles:
2011-2012: S1550
2009-2010: S5764

Sponsor Memo

BILL NUMBER:S132

TITLE OF BILL:
An act
to amend the social services law, in relation to authorizing a pilot
program for enhanced prior approval of high cost diagnostic radiology
services

PURPOSE OR GENERAL IDEA OF BILL:
Use of Radiology Benefit Management (RBM) services to reduce radiology
expenses on Medicaid recipients.

The may contract with qualified bidders to access the feasibility of
reducing medically unnecessary high cost radiological procedures
using selection criteria that includes using entities that utilize
and currently utilize only licensed radiologists, and are based in
New York.

JUSTIFICATION:
Redundant high tech imaging, typically classified as MRI, CTs, and Pet
scans, pose a significant concern, as there are few strategies to
manage it, while the ramifications of repeat radiation exposure, and
the high cost to patients is of great concern.

RBMs have been successful in reducing and containing rising cost and
utilization related to diagnostic imaging. The factors that
contribute to the growth of these costs are likely to persist because
they include an aging population, and advances in diagnostic imaging
technology.

PRIOR LEGISLATIVE HISTORY:
S..5764 of 2009
06/03/09 Referred to Social Services
07/16/09 Committee Discharged and Committed to Rules
07/16/09 Ordered to Third Reading Cal. 926
07/16/09 Passed Senate
07/16/09 Delivered to Assembly
07/17/09 Referred to Health
01/06/10 Died in Assembly
01/06/10 Returned to Senate
01/06/10 Referred to Social Services
03/04/10 Committee Discharged and Committed to Health
S.1550 of 2011
01/10/11 REFERRED TO SOCIAL SERVICES
01/04/12 REFERRED TO SOCIAL SERVICES

FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:
Projected 2009-2010 savings $2.3 million. Projected 2010-2011 savings
$5.8 million.

EFFECTIVE DATE:
This act shall take effect immediately.

view bill text
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                   132

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                               (PREFILED)

                             January 9, 2013
                               ___________

Introduced  by  Sen. SAMPSON -- 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  authorizing  a
  pilot  program  for  enhanced  prior  approval of high cost diagnostic
  radiology services

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1. The social services law is amended by adding a new section
369-gg to read as follows:
  S 369-GG. PILOT PROGRAM FOR ENHANCED PRIOR APPROVAL OF HIGH COST DIAG-
NOSTIC  RADIOLOGY  SERVICES.  1.  PURSUANT  TO   SECTION   ONE   HUNDRED
SIXTY-THREE  OF THE STATE FINANCE LAW, THE COMMISSIONER OF HEALTH SHALL,
WITHIN THE FISCAL YEAR OF TWO THOUSAND THIRTEEN--TWO THOUSAND  FOURTEEN,
CONTRACT  WITH QUALIFIED BIDDERS TO PERFORM PILOT PROJECTS TO ASSESS THE
FEASIBILITY OF REDUCING MEDICALLY  UNNECESSARY  HIGH  COST  RADIOLOGICAL
PROCEDURES  AND  GENERALIZING COST SAVINGS TO THE STATE THROUGH ENHANCED
MEDICAL MANAGEMENT AND PRIOR REVIEW OF ORDERS FOR DIAGNOSTIC IMAGING.
  2. THE COMMISSIONER OF HEALTH SHALL SELECT AN ENTITY TO  PERFORM  SUCH
PILOT PROJECT UTILIZING THE FOLLOWING SELECTION CRITERIA:
  (A) THE ENTITY SHALL HAVE AT LEAST ONE YEAR'S EXPERIENCE UTILIZING AND
CURRENTLY   UTILIZING   LICENSED  PROFESSIONALS  TO  CONDUCT  INTAKE  OF
PATIENTS;
  (B) THE ENTITY SHALL HAVE AT LEAST ONE YEAR'S EXPERIENCE UTILIZING AND
CURRENTLY UTILIZING ONLY LICENSED  RADIOLOGISTS  TO  MAKE  PRIOR  REVIEW
DETERMINATIONS;
  (C) THE ENTITY SHALL HAVE AT LEAST ONE YEAR'S EXPERIENCE UTILIZING AND
CURRENTLY UTILIZING LICENSED RADIOLOGISTS TO REQUEST ADDITIONAL INFORMA-
TION, AS NECESSARY, FROM THE TREATING PROVIDER;
  (D)  THE  ENTITY SHALL BE BASED IN NEW YORK AND AT LEAST FIFTY PERCENT
OF THE ENTITY'S EMPLOYEES SHALL RESIDE IN NEW YORK.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD01274-01-3

S. 132                              2

  S 2. If any clause, sentence, paragraph, section or part of  this  act
shall  be adjudged by any court of competent jurisdiction to be invalid,
such judgment shall not affect,  impair,  or  invalidate  the  remainder
thereof, but shall be confined in its operation to the clause, sentence,
paragraph, section, or part thereof directly involved in the controversy
in which such judgment shall have been rendered.
  S 3. This act shall take effect immediately.

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