Assembly Bill A463A

Signed By Governor
2023-2024 Legislative Session

Requires notice of adverse step therapy determinations

download bill text pdf

Sponsored By

Current Bill Status - Signed by Governor


  • 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

co-Sponsors

2023-A463 - Details

See Senate Version of this Bill:
S2677
Law Section:
Insurance Law
Laws Affected:
Amd §§4902 & 4903, Ins L; amd §§4902 & 4903, Pub Health L
Versions Introduced in 2021-2022 Legislative Session:
A9265, S8194

2023-A463 - Summary

Requires written notice of an adverse determination made by a utilization review agent in relation to a step therapy protocol override determination.

2023-A463 - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                    463
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              January 9, 2023
                                ___________
 
 Introduced  by M. of A. McDONALD, STECK -- read once and referred to the
   Committee on Insurance
 
 AN ACT to amend the insurance law and the public health law, in relation
   to requiring notice of adverse step therapy determinations
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Subsection  (a)  of  section 4902 of the insurance law is
 amended by adding a new paragraph 14 to read as follows:
   (14) ESTABLISHMENT OF A WRITTEN PROCEDURE TO ASSURE THAT THE NOTICE OF
 AN ADVERSE DETERMINATION IN RELATION TO A STEP THERAPY PROTOCOL OVERRIDE
 DETERMINATION REQUEST INCLUDES:
   (I) THE REASONS FOR THE DETERMINATION INCLUDING THE  CLINICAL  RATION-
 ALE, IF ANY;
   (II)  INSTRUCTIONS  ON  HOW TO INITIATE STANDARD AND EXPEDITED APPEALS
 PURSUANT TO SECTION FOUR THOUSAND NINE HUNDRED FOUR OF THIS ARTICLE  AND
 AN  EXTERNAL APPEAL PURSUANT TO SECTION FOUR THOUSAND NINE HUNDRED FOUR-
 TEEN OF THIS ARTICLE;
   (III) INFORMATION THAT INCLUDES: ANY  APPLICABLE  ALTERNATIVE  COVERED
 MEDICATIONS;  THE  CLINICAL  REVIEW  CRITERIA  RELIED  UPON TO MAKE SUCH
 DETERMINATION; AND ANY ADDITIONAL NECESSARY  INFORMATION  THAT  MUST  BE
 PROVIDED  TO,  OR  OBTAINED BY, THE UTILIZATION REVIEW AGENT IN ORDER TO
 RENDER A DECISION ON THE APPEAL.
   § 2. Section 4903 of the insurance law is  amended  by  adding  a  new
 subsection (e-1) to read as follows:
   (E-1)  NOTICE OF AN ADVERSE DETERMINATION MADE BY A UTILIZATION REVIEW
 AGENT IN RELATION TO A  STEP  THERAPY  PROTOCOL  OVERRIDE  DETERMINATION
 REQUEST SHALL BE MADE IN WRITING TO THE INSURED OR THE INSURED'S AUTHOR-
 IZED  REPRESENTATIVE  AND  THE INSURED'S PRESCRIBING HEALTH CARE PROFES-
 SIONAL AS DEFINED IN SUBSECTION (F) OF  SECTION  FORTY-NINE  HUNDRED  OF
 THIS CHAPTER, AND SHALL INCLUDE:
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD02500-01-3
 A. 463                              2
              

co-Sponsors

2023-A463A (ACTIVE) - Details

See Senate Version of this Bill:
S2677
Law Section:
Insurance Law
Laws Affected:
Amd §§4902 & 4903, Ins L; amd §§4902 & 4903, Pub Health L
Versions Introduced in 2021-2022 Legislative Session:
A9265, S8194

2023-A463A (ACTIVE) - Summary

Requires written notice of an adverse determination made by a utilization review agent in relation to a step therapy protocol override determination.

2023-A463A (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  463--A
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              January 9, 2023
                                ___________
 
 Introduced  by  M.  of  A.  McDONALD,  STECK, GUNTHER, STIRPE, K. BROWN,
   WEPRIN, COLTON, BENDETT -- read once and referred to the Committee  on
   Insurance  -- reported and referred to the Committee on Rules -- Rules
   Committee discharged, bill amended, ordered reprinted as  amended  and
   recommitted to the Committee on Rules

 AN ACT to amend the insurance law and the public health law, in relation
   to requiring notice of adverse step therapy determinations
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subsection (a) of section 4902  of  the  insurance  law  is
 amended by adding a new paragraph 14 to read as follows:
   (14) ESTABLISHMENT OF A WRITTEN PROCEDURE TO ASSURE THAT THE NOTICE OF
 AN ADVERSE DETERMINATION IN RELATION TO A STEP THERAPY PROTOCOL OVERRIDE
 DETERMINATION REQUEST INCLUDES:
   (I)  THE  REASONS FOR THE DETERMINATION INCLUDING THE CLINICAL RATION-
 ALE, IF ANY;
   (II) INSTRUCTIONS ON HOW TO INITIATE STANDARD  AND  EXPEDITED  APPEALS
 PURSUANT  TO SECTION FOUR THOUSAND NINE HUNDRED FOUR OF THIS ARTICLE AND
 AN EXTERNAL APPEAL PURSUANT TO SECTION FOUR THOUSAND NINE HUNDRED  FOUR-
 TEEN OF THIS ARTICLE;
   (III)  INFORMATION  THAT  INCLUDES: ANY APPLICABLE ALTERNATIVE COVERED
 MEDICATIONS; THE CLINICAL REVIEW  CRITERIA  RELIED  UPON  TO  MAKE  SUCH
 DETERMINATION;  AND  ANY  ADDITIONAL  NECESSARY INFORMATION THAT MUST BE
 PROVIDED TO, OR OBTAINED BY, THE UTILIZATION REVIEW AGENT  IN  ORDER  TO
 RENDER A DECISION ON THE APPEAL;
   (IV)  THE PROVISIONS OF THIS SECTION SHALL BE SATISFIED BY MAKING SUCH
 INFORMATION AVAILABLE ELECTRONICALLY ON  A  FORMULARY  WEBSITE,  ON  THE
 MEMBER  PORTAL AND/OR PROVIDER PORTAL OF THE INSURER'S, THE HEALTH MAIN-
 TENANCE ORGANIZATION'S  WEBSITE,  OR  THE  WEBSITE  OF  AN  ORGANIZATION
 SUBJECT TO ARTICLE FORTY-THREE OF THIS CHAPTER, PROVIDED THAT THE MEMBER
 CONSENTS TO RECEIVING THE INFORMATION ELECTRONICALLY.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD02500-03-3
              

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