Senate Bill S6435B

2021-2022 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 Senate Committee Rules 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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Bill Amendments

2021-S6435 - Details

See Assembly Version of this Bill:
A7129
Current Committee:
Senate Rules
Law Section:
Public Health Law
Laws Affected:
Amd §§4902 & 4903, Pub Health L; amd §§4902, 4903 & 3238, Ins L
Versions Introduced in Other Legislative Sessions:
2017-2018: S7872, A9588
2019-2020: S2847, A3038
2023-2024: S3400, A7268

2021-S6435 - Summary

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

2021-S6435 - Sponsor Memo

2021-S6435 - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   6435
 
                        2021-2022 Regular Sessions
 
                             I N  S E N A T E
 
                              April 28, 2021
                                ___________
 
 Introduced  by  Sen. BRESLIN -- 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 separately amended by section 13 of part YY and section 3
 of part KKK of chapter 56 of the laws of 2020, 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, WITHIN TWENTY-FOUR HOURS OF THE RECEIPT OF NECES-
 SARY INFORMATION IF THE REQUEST IS FOR AN ENROLLEE WITH A MEDICAL CONDI-
 TION  THAT  PLACES THE HEALTH OF THE INSURED IN SERIOUS JEOPARDY WITHOUT
 THE HEALTH CARE SERVICES  RECOMMENDED  BY  THE  ENROLLEE'S  HEALTH  CARE
 PROFESSIONAL,  or  for  inpatient  rehabilitation  services following an
 inpatient hospital admission provided by a hospital or  skilled  nursing
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

co-Sponsors

2021-S6435A - Details

See Assembly Version of this Bill:
A7129
Current Committee:
Senate Rules
Law Section:
Public Health Law
Laws Affected:
Amd §§4902 & 4903, Pub Health L; amd §§4902, 4903 & 3238, Ins L
Versions Introduced in Other Legislative Sessions:
2017-2018: S7872, A9588
2019-2020: S2847, A3038
2023-2024: S3400, A7268

2021-S6435A - Summary

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

2021-S6435A - Sponsor Memo

2021-S6435A - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  6435--A
 
                        2021-2022 Regular Sessions
 
                             I N  S E N A T E
 
                              April 28, 2021
                                ___________
 
 Introduced  by  Sen. BRESLIN -- read twice and ordered printed, and when
   printed to be committed  to  the  Committee  on  Health  --  committee
   discharged, bill amended, ordered reprinted as amended and recommitted
   to said committee
 
 AN ACT to amend the public health law and the insurance law, in relation
   to  utilization  review  program standards, and in relation to pre-au-
   thorization 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  TAKE  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 separately amended by section 13 of part YY and section 3
 of  part  KKK  of  chapter 56 of the laws of 2020, 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] SEVENTY-TWO HOURS of receipt of the
 necessary information, WITHIN TWENTY-FOUR HOURS OF THE RECEIPT OF NECES-
 SARY INFORMATION IF THE REQUEST IS FOR AN ENROLLEE WITH A MEDICAL CONDI-
 TION THAT PLACES THE HEALTH OF THE INSURED IN SERIOUS  JEOPARDY  WITHOUT
 THE  HEALTH  CARE  SERVICES  RECOMMENDED  BY  THE ENROLLEE'S HEALTH CARE
 PROFESSIONAL, or for  inpatient  rehabilitation  services  following  an
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

co-Sponsors

2021-S6435B (ACTIVE) - Details

See Assembly Version of this Bill:
A7129
Current Committee:
Senate Rules
Law Section:
Public Health Law
Laws Affected:
Amd §§4902 & 4903, Pub Health L; amd §§4902, 4903 & 3238, Ins L
Versions Introduced in Other Legislative Sessions:
2017-2018: S7872, A9588
2019-2020: S2847, A3038
2023-2024: S3400, A7268

2021-S6435B (ACTIVE) - Summary

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

2021-S6435B (ACTIVE) - Sponsor Memo

2021-S6435B (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  6435--B
 
                        2021-2022 Regular Sessions
 
                             I N  S E N A T E
 
                              April 28, 2021
                                ___________
 
 Introduced by Sens. BRESLIN, CLEARE, GALLIVAN, KENNEDY -- read twice and
   ordered  printed, and when printed to be committed to the Committee on
   Health -- committee discharged, bill  amended,  ordered  reprinted  as
   amended  and  recommitted  to  said  committee  --  recommitted to the
   Committee on Health in accordance  with  Senate  Rule  6,  sec.  8  --
   committee  discharged,  bill amended, ordered reprinted as amended and
   recommitted to said committee
 
 AN ACT to amend the public health law and the insurance law, in relation
   to utilization review program standards, and in  relation  to  pre-au-
   thorization 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 TAKE 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 separately amended by section 13 of part YY and section 3
 of part KKK of chapter 56 of the laws of 2020, 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] SEVENTY-TWO HOURS of receipt of the
 necessary information, WITHIN TWENTY-FOUR HOURS OF THE RECEIPT OF NECES-
 SARY INFORMATION IF THE REQUEST IS FOR AN ENROLLEE WITH A MEDICAL CONDI-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD03897-06-2
              

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