Assembly Bill A10248

Signed By Governor
2011-2012 Legislative Session

Directs the commissioner of health to develop a standard prior prescription drug authorization request form for managed care providers

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Archive: Last Bill Status - 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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Bill Amendments

co-Sponsors

multi-Sponsors

2011-A10248 - Details

Law Section:
Public Health Law
Laws Affected:
Amd §4903, Pub Health L; amd §4903, Ins L

2011-A10248 - Summary

Directs the commissioner of health to develop a standard prior prescription drug authorization request form for managed care providers.

2011-A10248 - Bill Text download pdf 

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

                                  10248

                          I N  A S S E M B L Y

                              May 16, 2012
                               ___________

Introduced by M. of A. P. RIVERA, GOTTFRIED -- read once and referred to
  the Committee on Health

AN ACT to amend the public health law and the insurance law, in relation
  to prior authorization for prescription drug benefits

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

  Section 1. Subdivisions 2 and 7 of section 4903 of the  public  health
law,  subdivision  2  as  added  by  chapter 705 of the laws of 1996 and
subdivision 7 as added by chapter 586 of the laws of 1998,  are  amended
and a new subdivision 8 is added to read as follows:
  2. A utilization review agent shall make a utilization review determi-
nation  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 of receipt of the necessary  informa-
tion.  A UTILIZATION REVIEW AGENT SHALL MAKE A UTILIZATION REVIEW DETER-
MINATION  INVOLVING  A REQUEST FOR PRESCRIPTION DRUG BENEFITS WITHIN TWO
BUSINESS DAYS OF RECEIPT OF THE NECESSARY INFORMATION,  AND  WITHIN  ONE
DAY  IF  THE  REQUEST  IS SUBMITTED BY ELECTRONIC MEANS. AS SET FORTH IN
SUBDIVISION EIGHT OF THIS SECTION, SUCH REQUEST  FOR  PRESCRIPTION  DRUG
BENEFITS  SHALL  BE  ON A FORM TO BE DEVELOPED BY THE DEPARTMENT AND THE
DEPARTMENT OF FINANCIAL SERVICES. A HEALTH CARE PLAN SHALL  ACCEPT  SUCH
FORM  AS SUFFICIENT TO REQUEST PRIOR AUTHORIZATION FOR PRESCRIPTION DRUG
BENEFITS.
  7. Failure by the utilization review agent  to  make  a  determination
within the time periods prescribed in this section shall be deemed to be
an  adverse  determination  subject to appeal pursuant to section [forty
nine] FORTY-NINE hundred four of this title; PROVIDED, HOWEVER, THAT THE
FAILURE BY THE UTILIZATION REVIEW AGENT  TO  MAKE  A  DETERMINATION  FOR
PRESCRIPTION  DRUG BENEFITS WITHIN THE TIME FRAMES SPECIFIED IN SUBDIVI-
SION TWO OF THIS SECTION  SHALL  RESULT  IN  THE  REQUEST  BEING  DEEMED
APPROVED.
  8.  (A)  THE DEPARTMENT AND THE DEPARTMENT OF FINANCIAL SERVICES SHALL
JOINTLY DEVELOP A UNIFORM PRIOR  AUTHORIZATION  FORM  FOR  REQUESTS  FOR

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

co-Sponsors

multi-Sponsors

2011-A10248A - Details

Law Section:
Public Health Law
Laws Affected:
Amd §4903, Pub Health L; amd §4903, Ins L

2011-A10248A - Summary

Directs the commissioner of health to develop a standard prior prescription drug authorization request form for managed care providers.

2011-A10248A - Bill Text download pdf 

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

                                10248--A

                          I N  A S S E M B L Y

                              May 16, 2012
                               ___________

Introduced  by  M.  of  A. P. RIVERA, GOTTFRIED, CAMARA, CASTRO, CRESPO,
  CYMBROWITZ,  SCARBOROUGH,  ARROYO,  AUBRY,  BROOK-KRASNY,   ZEBROWSKI,
  GIBSON,  N. RIVERA,  HOOPER,  RODRIGUEZ, GUNTHER, MAGNARELLI, ROBERTS,
  LIFTON,  LINARES,  ROSENTHAL,  JAFFEE,  BENEDETTO,  COLTON,  DINOWITZ,
  MONTESANO,  ABINANTI,  REILLY,  SIMANOWITZ,  MAISEL,  JACOBS, BURLING,
  BOYLAND, ABBATE, WEISENBERG, PERRY -- Multi-Sponsored by -- M.  of  A.
  BRENNAN,  BRONSON,  CLARK,  COOK,  CROUCH,  GLICK,  LATIMER,  LUPARDO,
  PEOPLES-STOKES, SWEENEY,  THIELE,  TITONE,  TITUS  --  read  once  and
  referred  to  the  Committee  on  Health -- committee discharged, bill
  amended, ordered reprinted as amended and recommitted to said  commit-
  tee

AN ACT to amend the public health law and the insurance law, in relation
  to  utilization  review  and prior authorization for prescription drug
  benefits

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

  Section  1.  Subdivisions 2 and 7 of section 4903 of the public health
law, subdivision 2 as added by chapter 705  of  the  laws  of  1996  and
subdivision  7  as added by chapter 586 of the laws of 1998, are amended
and a new subdivision 8 is added to read as follows:
  2. A utilization review agent shall make a utilization review determi-
nation 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 of receipt of the necessary informa-
tion.  A UTILIZATION REVIEW AGENT SHALL MAKE A UTILIZATION REVIEW DETER-
MINATION INVOLVING A REQUEST FOR PRESCRIPTION DRUG BENEFITS  WITHIN  TWO
BUSINESS  DAYS  OF  RECEIPT OF THE NECESSARY INFORMATION, AND WITHIN ONE
DAY IF THE REQUEST IS SUBMITTED BY ELECTRONIC MEANS.  AS  SET  FORTH  IN
SUBDIVISION  EIGHT  OF  THIS  SECTION,  A UTILIZATION REVIEW AGENT SHALL
ACCEPT THE MAKING OF SUCH REQUEST FOR PRESCRIPTION DRUG BENEFITS ON  THE
STANDARD FORM TO BE DEVELOPED BY THE COMMISSIONER AND THE SUPERINTENDENT
OF  FINANCIAL SERVICES UNDER SUBDIVISION EIGHT OF THIS SECTION. A HEALTH

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD15817-02-2

co-Sponsors

multi-Sponsors

2011-A10248B (ACTIVE) - Details

Law Section:
Public Health Law
Laws Affected:
Amd §4903, Pub Health L; amd §4903, Ins L

2011-A10248B (ACTIVE) - Summary

Directs the commissioner of health to develop a standard prior prescription drug authorization request form for managed care providers.

2011-A10248B (ACTIVE) - Bill Text download pdf 

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

                                10248--B

                          I N  A S S E M B L Y

                              May 16, 2012
                               ___________

Introduced  by  M.  of  A. P. RIVERA, GOTTFRIED, CAMARA, CASTRO, CRESPO,
  CYMBROWITZ,  SCARBOROUGH,  ARROYO,  AUBRY,  BROOK-KRASNY,   ZEBROWSKI,
  GIBSON,  N. RIVERA,  HOOPER,  RODRIGUEZ, GUNTHER, MAGNARELLI, ROBERTS,
  LIFTON,  LINARES,  ROSENTHAL,  JAFFEE,  BENEDETTO,  COLTON,  DINOWITZ,
  MONTESANO,  ABINANTI,  REILLY,  SIMANOWITZ,  MAISEL,  JACOBS, BURLING,
  BOYLAND, ABBATE, WEISENBERG, PERRY, SCHIMEL, WEPRIN, GABRYSZAK,  STEV-
  ENSON,  TITONE,  ESPINAL  --  Multi-Sponsored  by -- M. of A. BRENNAN,
  BRONSON, CLARK, COOK, CROUCH, GLICK, HEASTIE, LATIMER, LENTOL,  LUPAR-
  DO,  MAGEE,  MILLMAN,  PEOPLES-STOKES,  RUSSELL,  SKARTADOS,  SWEENEY,
  THIELE, TITUS, WEINSTEIN -- read once and referred to the Committee on
  Health -- committee discharged, bill  amended,  ordered  reprinted  as
  amended  and recommitted to said committee -- reported and referred to
  the Committee on Ways and Means -- committee discharged, bill amended,
  ordered reprinted as amended and recommitted to said committee

AN ACT to amend the social services law, in relation  to  directing  the
  commissioner  of  health to develop a standard prior prescription drug
  authorization request form for managed care providers

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

  Section  1.  Section  364-j  of  the social services law is amended by
adding a new subdivision 26 to read as follows:
  26. THE COMMISSIONER OF HEALTH SHALL DEVELOP A STANDARD PRIOR AUTHORI-
ZATION REQUEST FORM OR FORMS TO BE UTILIZED BY ALL MANAGED CARE  PROVID-
ERS FOR PURPOSES OF SUBMITTING A REQUEST FOR A UTILIZATION REVIEW DETER-
MINATION  FOR  COVERAGE  OF PRESCRIPTION DRUG BENEFITS UNDER THIS TITLE.
THE MANAGED CARE PROVIDER SHALL MAKE THE  STANDARD  PRIOR  AUTHORIZATION
REQUEST  FORM  OR  FORMS AVAILABLE TO, AND SHALL ACCEPT IT OR THEM FROM,
PRESCRIBING PROVIDERS IN PAPER AND ELECTRONIC FORM.
  S 2. This act shall take effect immediately; provided,  however,  that
the  amendment  to  section  364-j  of  the social services law, made by
section one of this act shall not affect the repeal of such section  and
shall be deemed repealed therewith.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD15817-03-2

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