NY State Senate Bill 2023-S4787A

Senate Bill S4787A

2023-2024 Legislative Session

Requires periodic reviews of pending applications for material change in the coverage status of certain matters relative to new health technology assessment or medical evidence

download bill text pdf

Current Bill Status - On Floor Calendar

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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Actions

View Actions

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Apr 02, 2024	amended on third reading 4787a
Feb 26, 2024	advanced to third reading
Feb 14, 2024	2nd report cal.
Feb 13, 2024	1st report cal.451
Jan 03, 2024	referred to health returned to senate died in assembly
May 31, 2023	referred to ways and means delivered to assembly passed senate
May 15, 2023	advanced to third reading
May 10, 2023	2nd report cal.
May 09, 2023	1st report cal.850
Feb 14, 2023	referred to health

Votes

- May 31, 2023 - Floor Vote
  S4787A
  
  58
  
  Aye
  
  0
  
  Nay
  
  0
  
  Absent
  
  5
  
  Excused
  
  0
  
  Abstained
  - - Floor Vote: May 31, 2023
      
      aye (58)
      
      Addabbo Jr.
      
      Bailey
      
      Borrello
      
      Breslin
      
      Brisport
      
      Brouk
      
      Canzoneri-Fitzpatrick
      
      Chu
      
      Cleare
      
      Comrie
      
      Fernandez
      
      Gallivan
      
      Gianaris
      
      Gonzalez
      
      Gounardes
      
      Griffo
      
      Harckham
      
      Helming
      
      Hinchey
      
      Hoylman-Sigal
      
      Jackson
      
      Kavanagh
      
      Kennedy
      
      Krueger
      
      Lanza
      
      Liu
      
      Mannion
      
      Martinez
      
      Mattera
      
      May
      
      Mayer
      
      Murray
      
      Myrie
      
      O'Mara
      
      Oberacker
      
      Ortt
      
      Palumbo
      
      Parker
      
      Persaud
      
      Ramos
      
      Rhoads
      
      Rivera
      
      Rolison
      
      Ryan
      
      Salazar
      
      Sanders Jr.
      
      Scarcella-Spanton
      
      Sepúlveda
      
      Serrano
      
      Skoufis
      
      Stavisky
      
      Stec
      
      Stewart-Cousins
      
      Tedisco
      
      Thomas
      
      Walczyk
      
      Webb
      
      Weber
      
      excused (5)
      
      Ashby
      
      Cooney
      
      Felder
      
      Martins
      
      Weik
  Feb 13, 2024 - Health Committee Vote
  S4787A
  
  15
  
  Aye
  
  0
  
  Nay
  
  0
  
  Aye with Reservations
  
  0
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  - - Health Committee Vote: Feb 13, 2024
      
      aye (15)
      
      Ashby
      
      Brouk
      
      Felder
      
      Gallivan
      
      Hoylman-Sigal
      
      Mannion
      
      Martins
      
      May
      
      Myrie
      
      Rhoads
      
      Rivera
      
      Salazar
      
      Stec
      
      Thomas
      
      Webb
  May 9, 2023 - Health Committee Vote
  S4787A
  
  15
  
  Aye
  
  0
  
  Nay
  
  0
  
  Aye with Reservations
  
  0
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  - - Health Committee Vote: May 9, 2023
      
      aye (15)
      
      Ashby
      
      Brouk
      
      Felder
      
      Gallivan
      
      Hoylman-Sigal
      
      Mannion
      
      Martins
      
      May
      
      Myrie
      
      Rhoads
      
      Rivera
      
      Salazar
      
      Stec
      
      Thomas
      
      Webb

Bill Amendments

Original

A (Active)

co-Sponsors

2023-S4787 - Details

See Assembly Version of this Bill:: A6022
Law Section:: Social Services Law
Laws Affected:: Amd §365-d, Soc Serv L
Versions Introduced in 2021-2022 Legislative Session:: S6973, A9289

2023-S4787 - Summary

Requires periodic reviews of pending applications for material change in the coverage status of certain matters relative to new health technology assessment or medical evidence.

2023-S4787 - Sponsor Memo

                                 
BILL NUMBER: S4787

SPONSOR: RIVERA
 
TITLE OF BILL:

An act to amend the social services law, in relation to requiring peri-
odic reviews of pending applications for material change in the coverage
status of certain matters relative to new health technology assessment
or medical evidence

 
PURPOSE:

Requires periodic reviews of pending applications for material change in
the coverage status of certain matters relative to new health technology
assessment or medical evidence.

 
SUMMARY OF SPECIFIC PROVISIONS:

Section 1 amends subdivision 5 of section 365-d of the social services
law as it relates to applications for Medicaid coverage. This section
outlines the review and reporting requirements that the commissioner
shall undertake when reviewing pending applications for material change

in the coverage status of a particular item, health technology assess-
ment or services, and anything relative to new health technology assess-
ments.

Section 2 provides the effective date

 
JUSTIFICATION:

In 2015, the Evidence Based Benefits Review Advisory Committee (EBBRAC)
was established to accept evidence from providers of services and tech-
nologies for the purpose of determining whether Medicaid should cover
such services or technologies. The Department of Health (DOH) was
authorized to contract with a consultant to review the dossiers submit-
ted by provider applicants.

From 2015 through 2017, the vendor selected by the DOH to review provid-
er applications was Oregon Health Sciences. In 2017, that vendor's
contract was terminated; however, no new vendor has been selected. As
EBBRAC is the mandated body to review such applications, the lack of a
vendor to review submitted evidence has severely hampered its ability to
approve new technologies or services and has likewise left providers of
new technologies or services without an avenue to secure Medicaid cover-
age. As EBBRAC's website shows, it has not met since 2017.

This bill would amend the EBBRAC process to ensure that the DOH main-
tains the ability to approve or disapprove new technologies or services
without a vendor. It also provides a meaningful and transparent process
for providers who seek to have such technology or service covered by
Medicaid.

 
LEGISLATIVE HISTORY:

2021-2022: S6973 / A9289 Gottfried

 
FISCAL IMPLICATIONS:

None.
 
EFFECTIVE DATE:
This act shall take effect immediately.

2023-S4787 - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   4787
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                             February 14, 2023
                                ___________
 
 Introduced by Sens. RIVERA, RAMOS -- read twice and ordered printed, and
   when printed to be committed to the Committee on Health
 
 AN  ACT to amend the social services law, in relation to requiring peri-
   odic reviews of pending applications for material change in the cover-
   age status of  certain  matters  relative  to  new  health  technology
   assessment or medical evidence
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subdivision 5 of section 365-d of the social services  law,
 as added by section 46-a of part B of chapter 57 of the laws of 2015, is
 amended to read as follows:
   5.  (A)  THE  COMMISSIONER,  IN CONSULTATION WITH THE COMMITTEE, SHALL
 UNDERTAKE PERIODIC REVIEWS OF PENDING APPLICATIONS FOR  MATERIAL  CHANGE
 IN  THE  COVERAGE  STATUS  OF  A  PARTICULAR  ITEM, HEALTH TECHNOLOGY OR
 SERVICE, AND ANY MATTER RELATIVE TO NEW HEALTH TECHNOLOGY ASSESSMENT  OR
 MEDICAL  EVIDENCE FOR WHICH AN APPLICANT HAS SUBMITTED A COMPLETE APPLI-
 CATION TO THE DEPARTMENT WITHIN THREE MONTHS OF RECEIPT. THE  DEPARTMENT
 SHALL  NOTIFY  AN  APPLICANT  OF  INCOMPLETENESS  WITHIN  THIRTY DAYS OF
 RECEIPT OF SUBMISSION. RECEIPT OF APPLICATIONS SHALL BE PUBLISHED ON THE
 DEPARTMENT'S WEBSITE WITHIN SEVEN  DAYS  OF  RECEIPT.  THE  COMMISSIONER
 SHALL  SCHEDULE A REVIEW OF SUCH PENDING APPLICATIONS AND CAUSE PUBLICA-
 TION OF THE DATE OF REVIEW ON THE DEPARTMENT'S WEBSITE WITHIN SEVEN DAYS
 OF THE REVIEW REQUIRED BY THIS PARAGRAPH.
   (B) THE COMMISSIONER, IN CONSULTATION WITH THE COMMITTEE, SHALL  ISSUE
 A  REPORT TO THE CHAIR OF THE STANDING COMMITTEE ON HEALTH IN THE SENATE
 AND ASSEMBLY AND PUBLISH THE REPORT ON THE DEPARTMENT'S  WEBSITE  WITHIN
 THIRTY  DAYS  OF REVIEW OF ANY PENDING APPLICATION PURSUANT TO PARAGRAPH
 (A) OF THIS SUBDIVISION. SUCH REPORT SHALL PROVIDE THE DATE OF  APPLICA-
 TION,  DATE  OF  REVIEW,  AND  A  STATED DETERMINATION OF SUFFICIENCY OF
 EVIDENCE WARRANTING COMMITTEE DELIBERATION AND  RECOMMENDATION.  IN  THE
 EVENT  OF  AN  AFFIRMATIVE DETERMINATION OF SUFFICIENCY OF EVIDENCE, THE
 COMMISSIONER SHALL REQUIRE THE COMMITTEE TO ISSUE A RECOMMENDATION WITH-
 IN SIX MONTHS OF SUCH DETERMINATION OF SUFFICIENCY. IN THE  EVENT  OF  A
 NEGATIVE DETERMINATION, THE COMMISSIONER SHALL DETAIL SUCH INSUFFICIENCY

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD08099-01-3
 S. 4787                             2
 
 OF  EVIDENCE  AND  ALLOW  THE  APPLICANT TO CURE STATED DEFICIENCIES FOR
 REVIEW UNDER THE REQUIREMENTS PROVIDED IN PARAGRAPH (A) OF THIS SUBDIVI-
 SION.
   (C) The committee shall consider any matter regarding material changes
 in  the  coverage  status  of  a  particular  item, health technology or
 service, and any matter relative to new health technology assessment  or
 medical evidence review for which the department determines a sufficient
 body  of  evidence exists to warrant committee deliberation. The commis-
 sioner shall provide members of  the  committee  with  any  evidence  or
 information  related to the health technology or medical service assess-
 ment including but not limited to, information submitted by  members  of
 the  public.  The  department shall report to the committee programmatic
 changes to benefits that do not rise to the level of a material  change,
 as  well as determinations of when sufficient medical evidence exists to
 warrant committee deliberations. The commissioner shall  provide  forty-
 five days public notice on the department's website prior to any meeting
 of the committee to develop recommendations concerning health technology
 or  medical service coverage determinations. Such notice shall include a
 description of the proposed health technology or service to be reviewed,
 the conditions or diseases impacted by the health technology or service,
 the proposals to be considered by  the  committee,  and  the  systematic
 evidence-based  assessment prepared in accordance with this subdivision.
 The committee shall allow interested parties a reasonable opportunity to
 make an oral presentation to the committee related to the  health  tech-
 nology or service to be reviewed and to submit written information.  The
 committee  shall  consider  any  information  provided by any interested
 party, including, but not limited to, health care providers, health care
 facilities, patients, consumers and manufacturers. For all health  tech-
 nologies  or  services selected for review, the department shall conduct
 or commission a systematic evidence-based assessment of the health tech-
 nology's or service's safety and clinical efficacy. The assessment shall
 use established systematic review elements,  study  quality  assessment,
 and  data  synthesis.  Upon  completion,  the systematic, evidence-based
 assessment shall be made available to the public.
   (D) THE COMMISSIONER SHALL MAKE A  DETERMINATION  OF  COVERAGE  WITHIN
 SIXTY DAYS OF THE ISSUANCE OF RECOMMENDATION BY THE COMMITTEE.
   (E) NOTWITHSTANDING ANY OTHER LAW OR REGULATION, IN THE EVENT A DETER-
 MINATION  OF  COVERAGE  STATUS IS NOT MADE UNDER THIS SECTION WITHIN ONE
 YEAR OF APPLICATION RECEIPT SUCH APPLICATION SHALL  BE  DEEMED  APPROVED
 FOR  COVERAGE  PROVIDED  SUCH  TECHNOLOGY  IS ALSO COVERED BY TWO OF THE
 FOLLOWING:
   (I) MEDICARE;
   (II) HEALTH PLANS AUTHORIZED UNDER ARTICLES THIRTY-TWO OR  FORTY-THREE
 OF THE INSURANCE LAW;
   (III) MEDICAID MANAGED CARE PLANS;
   (IV) THE BENCHMARK PLAN OF THE NEW YORK STATE OF HEALTH;
   (V) THE NEW YORK STATE HEALTH INSURANCE PLAN; OR
   (VI) THE WORKERS' COMPENSATION BOARD.
   (F)  TECHNOLOGIES  OR  SERVICES DENIED COVERAGE UNDER THIS SUBDIVISION
 MAY APPEAL SUCH DETERMINATION TO THE COMMISSIONER,  WHO  SHALL  ISSUE  A
 FINAL  DETERMINATION  OF COVERAGE WITHIN SIX MONTHS OF SUCH APPEAL. SUCH
 FINAL DETERMINATIONS SHALL BE SUBJECT TO ARTICLE  SEVENTY-EIGHT  OF  THE
 CIVIL PRACTICE LAW AND RULES.
   § 2. This act shall take effect immediately.

co-Sponsors

2023-S4787A (ACTIVE) - Details

See Assembly Version of this Bill:: A6022
Law Section:: Social Services Law
Laws Affected:: Amd §365-d, Soc Serv L
Versions Introduced in 2021-2022 Legislative Session:: S6973, A9289

2023-S4787A (ACTIVE) - Summary

Requires periodic reviews of pending applications for material change in the coverage status of certain matters relative to new health technology assessment or medical evidence.

2023-S4787A (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S4787A

SPONSOR: RIVERA
 
TITLE OF BILL:

An act to amend the social services law, in relation to requiring peri-
odic reviews of pending applications for material change in the coverage
status of certain matters relative to new health technology assessment
or medical evidence

 
PURPOSE:

Requires periodic reviews of pending applications for material change in
the coverage status of certain matters relative to new health technology
assessment or medical evidence.

 
SUMMARY OF SPECIFIC PROVISIONS:

Section 1 amends subdivision 5 of section 365-d of the social services
law as it relates to the Medicaid evidence based benefit review advisory
committee, and outlines their review and reporting requirements that the
Commissioner of Health, in consultation with the committee, would under-

take when reviewing pending applications for material change in the
coverage status of a particular item, health technology assessment or
services, and anything relative to new health technology assessments.

Section 2 provides the effective date

 
JUSTIFICATION:

In 2015, the Evidence Based Benefits Review Advisory Committee (EBBRAC)
was established to accept evidence from providers of services and tech-
nologies for the purpose of determining whether Medicaid should cover
such services or technologies. The Department of Health (DOH) was
authorized to contract with a consultant to review the dossiers submit-
ted by provider applicants.

From 2015 through 2017, the vendor selected by the DOH to review provid-
er applications was Oregon Health Sciences. In 2017, that vendor's
contract was terminated; however, no new vendor has been selected. As
EBBRAC is the mandated body to review such applications, the lack of a
vendor to review submitted evidence has severely hampered its ability to
approve new technologies or services and has likewise left providers of
new technologies or services without an avenue to secure Medicaid cover-
age. As EBBRAC's website shows, it has not met since 2017.

This bill would amend the EBBRAC process to ensure that the DOH main-
tains the ability to approve or disapprove new technologies or services
without a vendor. It also provides a meaningful and transparent process
for providers who seek to have such technology or service covered by
Medicaid.

 
LEGISLATIVE HISTORY:

2021-2022: S6973 / A9289 Gottfried

 
FISCAL IMPLICATIONS:

None.
 
EFFECTIVE DATE:
This act shall take effect immediately.

2023-S4787A (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  4787--A
     Cal. No. 451
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                             February 14, 2023
                                ___________
 
 Introduced by Sens. RIVERA, RAMOS -- read twice and ordered printed, and
   when printed to be committed to the Committee on Health -- recommitted
   to the Committee on Health in accordance with Senate Rule 6, sec. 8 --
   reported  favorably  from  said committee, ordered to first and second
   report, ordered to a third reading,  amended  and  ordered  reprinted,
   retaining its place in the order of third reading
 
 AN  ACT to amend the social services law, in relation to requiring peri-
   odic reviews of pending applications for material change in the cover-
   age status of  certain  matters  relative  to  new  health  technology
   assessment or medical evidence
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subdivision 5 of section 365-d of the social services  law,
 as added by section 46-a of part B of chapter 57 of the laws of 2015, is
 amended to read as follows:
   5.  (A)  THE  COMMISSIONER,  IN CONSULTATION WITH THE COMMITTEE, SHALL
 UNDERTAKE PERIODIC REVIEWS OF PENDING APPLICATIONS FOR  MATERIAL  CHANGE
 IN  THE  COVERAGE  STATUS  OF  A  PARTICULAR  ITEM, HEALTH TECHNOLOGY OR
 SERVICE, AND ANY MATTER RELATIVE TO NEW HEALTH TECHNOLOGY ASSESSMENT  OR
 MEDICAL  EVIDENCE FOR WHICH AN APPLICANT HAS SUBMITTED A COMPLETE APPLI-
 CATION TO THE DEPARTMENT WITHIN THREE MONTHS OF RECEIPT. THE  DEPARTMENT
 SHALL  NOTIFY  AN  APPLICANT  OF  INCOMPLETENESS  WITHIN  THIRTY DAYS OF
 RECEIPT OF SUBMISSION. RECEIPT OF APPLICATIONS SHALL BE PUBLISHED ON THE
 DEPARTMENT'S WEBSITE WITHIN SEVEN  DAYS  OF  RECEIPT.  THE  COMMISSIONER
 SHALL  SCHEDULE A REVIEW OF SUCH PENDING APPLICATIONS AND CAUSE PUBLICA-
 TION OF THE DATE OF REVIEW ON THE DEPARTMENT'S WEBSITE WITHIN SEVEN DAYS
 OF THE REVIEW REQUIRED BY THIS PARAGRAPH.
   (B) THE COMMISSIONER, IN CONSULTATION WITH THE COMMITTEE, SHALL  ISSUE
 A  REPORT TO THE CHAIR OF THE STANDING COMMITTEE ON HEALTH IN THE SENATE
 AND ASSEMBLY AND PUBLISH THE REPORT ON THE DEPARTMENT'S  WEBSITE  WITHIN
 THIRTY  DAYS  OF REVIEW OF ANY PENDING APPLICATION PURSUANT TO PARAGRAPH
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD08099-03-3
 S. 4787--A                          2
 
 (A) OF THIS SUBDIVISION. SUCH REPORT SHALL PROVIDE THE DATE OF  APPLICA-
 TION,  DATE  OF  REVIEW,  AND  A  STATED DETERMINATION OF SUFFICIENCY OF
 EVIDENCE WARRANTING COMMITTEE DELIBERATION AND  RECOMMENDATION.  IN  THE
 EVENT  OF  AN  AFFIRMATIVE DETERMINATION OF SUFFICIENCY OF EVIDENCE, THE
 COMMISSIONER SHALL REQUIRE THE COMMITTEE TO ISSUE A RECOMMENDATION WITH-
 IN SIX MONTHS OF SUCH DETERMINATION OF SUFFICIENCY. IN THE  EVENT  OF  A
 NEGATIVE DETERMINATION, THE COMMISSIONER SHALL DETAIL SUCH INSUFFICIENCY
 OF  EVIDENCE  AND  ALLOW  THE  APPLICANT TO CURE STATED DEFICIENCIES FOR
 REVIEW UNDER THE REQUIREMENTS PROVIDED IN PARAGRAPH (A) OF THIS SUBDIVI-
 SION.
   (C) The committee shall consider any matter regarding material changes
 in the coverage status  of  a  particular  item,  health  technology  or
 service,  and any matter relative to new health technology assessment or
 medical evidence review for which the department determines a sufficient
 body of evidence exists to warrant committee deliberation.  The  commis-
 sioner  shall  provide  members  of  the  committee with any evidence or
 information related to the health technology or medical service  assess-
 ment  including  but not limited to, information submitted by members of
 the public. The department shall report to  the  committee  programmatic
 changes  to benefits that do not rise to the level of a material change,
 as well as determinations of when sufficient medical evidence exists  to
 warrant  committee  deliberations. The commissioner shall provide forty-
 five days public notice on the department's website prior to any meeting
 of the committee to develop recommendations concerning health technology
 or medical service coverage determinations. Such notice shall include  a
 description of the proposed health technology or service to be reviewed,
 the conditions or diseases impacted by the health technology or service,
 the  proposals  to  be  considered  by the committee, and the systematic
 evidence-based assessment prepared in accordance with this  subdivision.
 The committee shall allow interested parties a reasonable opportunity to
 make  an  oral presentation to the committee related to the health tech-
 nology or service to be reviewed and to submit written information.  The
 committee shall consider any  information  provided  by  any  interested
 party, including, but not limited to, health care providers, health care
 facilities,  patients, consumers and manufacturers. For all health tech-
 nologies or services selected for review, the department  shall  conduct
 or commission a systematic evidence-based assessment of the health tech-
 nology's or service's safety and clinical efficacy. The assessment shall
 use  established  systematic  review elements, study quality assessment,
 and data synthesis.  Upon  completion,  the  systematic,  evidence-based
 assessment shall be made available to the public.
   § 2. This act shall take effect immediately.

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Senate Bill S4787A

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Sponsored By

Gustavo Rivera

Current Bill Status - On Floor Calendar

Bill Amendments

co-Sponsors

Jessica Ramos

2023-S4787 - Details

2023-S4787 - Summary

2023-S4787 - Sponsor Memo

2023-S4787 - Bill Text download pdf

co-Sponsors

Jessica Ramos

2023-S4787A (ACTIVE) - Details

2023-S4787A (ACTIVE) - Summary

2023-S4787A (ACTIVE) - Sponsor Memo

2023-S4787A (ACTIVE) - Bill Text download pdf

Comments