senate Bill S2847

2019-2020 Legislative Session

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

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Sponsored By

Current Bill Status - In Senate Committee Health Committee


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

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Actions

view actions (6)
Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Jan 08, 2020 referred to health
Jun 20, 2019 committed to rules
May 29, 2019 advanced to third reading
May 22, 2019 2nd report cal.
May 21, 2019 1st report cal.835
Jan 29, 2019 referred to health

Votes

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May 21, 2019 - Health committee Vote

S2847
14
0
committee
14
Aye
0
Nay
1
Aye with Reservations
0
Absent
0
Excused
0
Abstained
show Health committee vote details

Co-Sponsors

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S2847 (ACTIVE) - Details

See Assembly Version of this Bill:
A3038
Current Committee:
Senate Health
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 2017-2018 Legislative Session:
S7872, A9588

S2847 (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.

S2847 (ACTIVE) - Sponsor Memo

S2847 (ACTIVE) - Bill Text download pdf


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

                                  2847

                       2019-2020 Regular Sessions

                            I N  S E N A T E

                            January 29, 2019
                               ___________

Introduced  by  Sens. BRESLIN, AKSHAR, COMRIE, FUNKE, GALLIVAN, HOYLMAN,
  ORTT, ROBACH, SEPULVEDA -- read twice and ordered  printed,  and  when
  printed to be committed to the Committee on Health

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
to the enrollee's health care provider shall  be  transmitted  electron-

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

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