Assembly Bill A4996

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

                                  4996

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                            February 14, 2013
                               ___________

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

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

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD08746-01-3
              

A. 4996                             2

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
chapter,  as  if the prior authorization or prior approval determination
were made by a government entity, WITHOUT REGARD TO  EXPIRATION  OF  THE
PRIOR SERVICE AUTHORIZATION.
  S  3.  Subparagraph  (ii) of paragraph (a) of subdivision 7 of section
4403-f of the public health law, as amended by section 41-b of part H of
chapter 59 of the laws of 2011, is amended to read as follows:
  (ii) Notwithstanding any inconsistent provision of the social services
law to the contrary, the commissioner  shall,  pursuant  to  regulation,
determine  whether  and the extent to which the applicable provisions of
the social services law or regulations relating to approvals and author-
izations of, and utilization limitations on, health and long  term  care
services reimbursed pursuant to title XIX of the federal social security
act,  including, but not limited to, fiscal assessment requirements, are
inconsistent with the flexibility necessary for the  efficient  adminis-
tration  of  managed  long  term  care  plans and such regulations shall
provide that such provisions shall not be  applicable  to  enrollees  or
managed  long  term  care  plans,  provided that such determinations are
consistent with applicable federal law and regulation,  AND  SUBJECT  TO
THE   PROVISIONS   OF   SUBDIVISION   EIGHT  OF  SECTION  THREE  HUNDRED
SIXTY-FIVE-A OF THE SOCIAL SERVICES LAW.
  S 4. This act shall take effect immediately and  shall  apply  to  any
review  or  appeal  under  the social services law, public health law or
insurance law pending at the time it becomes a law;  provided,  however,
that  the  amendments to section 4403-f of the public health law made by
section three of this act shall not affect the repeal  of  such  section
and shall be deemed repealed therewith.