Assembly Actions -
Lowercase Senate Actions - UPPERCASE |
|
---|---|
Dec 22, 2023 |
approval memo.61 signed chap.735 |
Dec 12, 2023 |
delivered to governor |
Jun 07, 2023 |
returned to assembly passed senate 3rd reading cal.1179 substituted for s2677a |
Jun 05, 2023 |
referred to rules delivered to senate passed assembly ordered to third reading rules cal.483 rules report cal.483 reported |
May 25, 2023 |
amend and recommit to rules 463a |
May 17, 2023 |
reported referred to rules |
Jan 09, 2023 |
referred to insurance |
Assembly Bill A463
Signed By Governor2023-2024 Legislative Session
Sponsored By
MCDONALD
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
Actions
Votes
Bill Amendments
co-Sponsors
Phil Steck
Aileen Gunther
Albert A. Stirpe
Keith Brown
2023-A463 - Details
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
Phil Steck
Aileen Gunther
Albert A. Stirpe
Keith Brown
2023-A463A (ACTIVE) - Details
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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