| Date of Action |
Assembly Actions -
Lowercase Senate Actions - UPPERCASE |
|---|---|
| Feb 10, 2014 |
referred to social services |
Senate Bill S6586
2013-2014 Legislative Session
Sponsored By
(D, WF) 33rd Senate District
Archive: Last Bill Status - In Senate Committee Social Services Committee
Actions
2013-S6586 (ACTIVE) - Details
- Current Committee:
- Senate Social Services
- Law Section:
- Social Services Law
- Laws Affected:
- Amd §§22 & 365-a, Soc Serv L; amd §4403-f, Pub Health L
2013-S6586 (ACTIVE) - Sponsor Memo
BILL NUMBER:S6586
TITLE OF BILL: An act to amend the social services law and the public
health law, in relation to medicaid reviews and appeals
PURPOSE OR GENERAL IDEA OF BILL: To clarify that Medicaid enrollees
who have been denied services by a Medicaid managed care plan may file
for a fair hearing under the Social Services Law as well as internal
and external appeal under managed care laws, and are entitled to the
continuation of services as usual while appeals and fair hearings
proceed.
SUMMARY OF SPECIFIC PROVISIONS: The bill amends Social Services Law
22 and Public Health Law § 4403-F to assure that Medicaid enrollees do
not have to exhaust internal and external appeals of managed care plan
adverse determinations in order to proceed with Medicaid fair
hearings. The bill amends Social Services Law § 265-a to clarify that
health care services continue until the appeal(s) is resolved.
JUSTIFICATION: Medicaid recipients are increasingly moved into managed
care plans subject to the managed care internal and external appeal
processes. This is being used to assert that the recipients may not
file for a Social Services Law fair hearing until those managed care
appeals are exhausted. Unfortunately, this has the effect of depriving
recipients of their longstanding right to have services continue while
a fair hearing appeal is pending. This can have the effect of
2013-S6586 (ACTIVE) - Bill Text download pdf
S T A T E O F N E W Y O R K
________________________________________________________________________
6586
I N S E N A T E
February 10, 2014
___________
Introduced by Sen. RIVERA -- read twice and ordered printed, and when
printed to be committed to the Committee on Social Services
AN ACT to amend the social services law and the public health law, in
relation to medicaid reviews and appeals
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Section 22 of the social services law is amended by adding
a new subdivision 15 to read as follows:
15. WITH RESPECT TO MEDICAL ASSISTANCE UNDER TITLE ELEVEN OF ARTICLE
FIVE OF THIS CHAPTER, WHERE THE MEDICAL SERVICE AT ISSUE IS OR WOULD BE
PROVIDED BY AN ENTITY SUBJECT TO ARTICLE FORTY-NINE OF THE PUBLIC HEALTH
LAW OR ARTICLE FORTY-NINE OF THE INSURANCE LAW:
1. AN ENROLLEE SHALL NOT BE REQUIRED TO EXHAUST HIS OR HER REVIEW OR
APPEAL REMEDIES UNDER ARTICLE FORTY-NINE OF THE PUBLIC HEALTH LAW OR
ARTICLE FORTY-NINE OF THE INSURANCE LAW PRIOR TO REQUESTING A FAIR HEAR-
ING UNDER THIS SECTION OR ANY OTHER STATE OR FEDERAL LAW. HOWEVER, IN AN
APPROPRIATE CASE, THE HOLDING OR CONTINUING OF THE FAIR HEARING MAY BE
DELAYED PENDING THE OUTCOME OF SUCH REVIEW OR APPEAL.
2. THE RIGHTS AND REMEDIES CONFERRED UNDER THOSE PROVISIONS OF THE
PUBLIC HEALTH LAW OR THE INSURANCE LAW SHALL BE CUMULATIVE AND IN ADDI-
TION TO AND NOT IN LIEU OF ANY OTHER RIGHTS OR REMEDIES AVAILABLE UNDER
LAW.
S 2. Subdivision 8 of section 365-a of the social services law, as
added by section 46-a of part B of chapter 58 of the laws of 2009, is
amended to read as follows:
8. When a non-governmental entity is authorized by the department
pursuant to contract or subcontract to make prior authorization or prior
approval determinations that may be required for any item of medical
assistance, a recipient may challenge any action taken or failure to act
in connection with a prior authorization or prior approval determination
as if such determination were made by a government entity, and shall be
entitled to the same medical assistance benefits and standards and to
the same notice and procedural due process rights, including a right to
a fair hearing and aid continuing pursuant to section twenty-two of this
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
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