Assembly Bill A3038

2019-2020 Legislative Session

Relates to utilization review program standards and pre-authorization for certain health care services

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Archive: Last Bill Status - In Assembly 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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2019-A3038 (ACTIVE) - Details

See Senate Version of this Bill:
S2847
Current Committee:
Assembly Insurance
Law Section:
Public Health Law
Laws Affected:
Amd §§4902 & 4903, add §4909, Pub Health L; amd §§4902, 4903 & 3238, add §4909, Ins L
Versions Introduced in Other Legislative Sessions:
2017-2018: A9588, S7872
2021-2022: A7129, S6435
2023-2024: A7268, S3400

2019-A3038 (ACTIVE) - Summary

Relates to utilization review program standards; requires use of evidence-based and peer reviewed clinical review criteria; amends provisions relating to prescription drug formulary changes and pre-authorization for certain health care services.

2019-A3038 (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   3038
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 28, 2019
                                ___________
 
 Introduced by M. of A. GOTTFRIED, WOERNER, TAYLOR, SANTABARBARA, LIFTON,
   SOLAGES, CROUCH, BARRON, COLTON, BUCHWALD, D'URSO, LUPARDO, MONTESANO,
   MOSLEY,  ENGLEBRIGHT  --  read  once  and referred to the Committee on
   Insurance
 
 AN ACT to amend the public health law and the insurance law, in relation
   to utilization review program standards and prescription  drug  formu-
   lary changes during a contract year, and in relation to pre-authoriza-
   tion of health care services
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1.  Paragraph (c) of subdivision 1  of  section  4902  of  the
 public  health  law,  as  added  by  chapter 705 of the laws of 1996, is
 amended to read as follows:
   (c) Utilization of written clinical review criteria developed pursuant
 to a utilization  review  plan.  SUCH  CLINICAL  REVIEW  CRITERIA  SHALL
 UTILIZE  RECOGNIZED  EVIDENCE-BASED  AND  PEER  REVIEWED CLINICAL REVIEW
 CRITERIA THAT TAKES INTO ACCOUNT THE NEEDS OF A  TYPICAL  PATIENT  POPU-
 LATIONS AND DIAGNOSES;
   §  2.  Paragraph  (a)  of  subdivision 2 of section 4903 of the public
 health law, as amended by chapter 371 of the laws of 2015, is amended to
 read as follows:
   (a) A utilization review agent shall make a utilization review  deter-
 mination  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] FORTY-EIGHT HOURS of receipt of the
 necessary information, OR WITHIN TWENTY-FOUR HOURS  OF  THE  RECEIPT  OF
 NECESSARY  INFORMATION  IF THE REQUEST IS FOR AN ENROLLEE WITH A MEDICAL
 CONDITION THAT PLACES THE HEALTH OF  THE  INSURED  IN  SERIOUS  JEOPARDY
 WITHOUT  THE  HEALTH  CARE SERVICES RECOMMENDED BY THE ENROLLEE'S HEALTH
 CARE PROFESSIONAL. To the extent practicable, such written  notification
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

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