|Assembly Actions - Lowercase
Senate Actions - UPPERCASE
|Jun 02, 2022||returned to assembly|
|Jun 01, 2022||3rd reading cal.1658|
substituted for s8113
|Jun 01, 2022||substituted by a879|
|May 31, 2022||ordered to third reading cal.1658|
committee discharged and committed to rules
|Jan 25, 2022||referred to health|
senate Bill S8113
Current Bill Status Via A879 - Passed Senate & Assembly
- In Committee
- On Floor Calendar
- Passed Senate
- Passed Assembly
- Delivered to Governor
- Signed/Vetoed by Governor
S8113 (ACTIVE) - Details
S8113 (ACTIVE) - Sponsor Memo
BILL NUMBER: S8113 SPONSOR: CLEARE TITLE OF BILL: An act to amend the public health law and the insurance law, in relation to the definition of clinical peer reviewer PURPOSE OR GENERAL IDEA OF BILL: To ensure that a health plan may only deny payment for an otherwise covered benefit upon the review of a physician or other health care professional licensed in NYS and, when appropriate, board certified in the same or similar specialty as the treatment under review. SUMMARY OF SPECIFIC PROVISIONS: Section 1 of the bill would amend section 4900 of the Public Health Law to re-define the qualifications of a "clinical peer reviewer" who a, health plan or insurer may use to deny payment for an otherwise covered benefit on the basis that the treatment is not medically necessary. Under current law, only when a claim dispute arises to the level of an
S8113 (ACTIVE) - Bill Text download pdf
S T A T E O F N E W Y O R K ________________________________________________________________________ 8113 I N S E N A T E January 25, 2022 ___________ Introduced by Sen. CLEARE -- 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 the definition of clinical peer reviewer THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Subdivision 2 of section 4900 of the public health law, as amended by chapter 586 of the laws of 1998, item (B) of subparagraph (ii) of paragraph (a) as amended by chapter 41 of the laws of 2014 and subparagraph (iii) as amended and subparagraph (iv) of paragraph (a) as added by section 42 of subpart A of part BB of chapter 57 of the laws of 2019, is amended to read as follows: 2. "Clinical peer reviewer" means: (a) [for purposes of title one of this article: (i) a physician who possesses a current and valid non-restricted license to practice medicine; or (ii) a health care professional other than a licensed physician who: (A) where applicable, possesses a current and valid non-restricted license, certificate or registration or, where no provision for a license, certificate or registration exists, is credentialed by the national accrediting body appropriate to the profession; and (B) is in the same profession and same or similar specialty as the health care provider who typically manages the medical condition or disease or provides the health care service or treatment under review; or (iii) for purposes of a determination involving substance use disorder treatment: (A) a physician who possesses a current and valid non-restricted license to practice medicine and who specializes in behavioral health and has experience in the delivery of substance use disorder courses of treatment; or (B) a health care professional other than a licensed physician who specializes in behavioral health and has experience in the delivery of substance use disorder courses of treatment and, where applicable, EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted.
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