Assembly Bill A1936

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1936
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 14, 2025
                                ___________
 
 Introduced  by  M. of A. PAULIN, SAYEGH, LUCAS -- read once and referred
   to the Committee on Health
 
 AN ACT to amend the public health law, in  relation  to  prior  authori-
   zation and payments from the medical indemnity fund
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section 1. Paragraph (b) of subdivision 2 of  section  2999-j  of  the
 public  health  law,  as amended by section 3 of part K of chapter 57 of
 the laws of 2019, is amended and a new paragraph (b-1) is added to  read
 as follows:
   (b)  if  any  prior  authorization is required by such regulation, the
 regulation shall require that requests for prior authorization be  proc-
 essed  within  a  reasonably  prompt period of time and shall identify a
 process for prompt administrative review of any denial of a request  for
 prior authorization; [and]
   (B-1)  IF  ANY PRIOR AUTHORIZATION IS REQUIRED BY SUCH REGULATION, THE
 REGULATION SHALL REQUIRE ESTABLISHING  A  MECHANISM  FOR  SUBMISSION  OF
 REQUESTS  FOR  PRIOR  AUTHORIZATION BY HEALTH CARE PROVIDERS DIRECTLY TO
 THE FUND; AND
   § 2. Paragraph (b) of subdivision 8 of section 2999-j  of  the  public
 health  law,  as added by section 52 of part H of chapter 59 of the laws
 of 2011, is amended and a new paragraph (c) is added to read as follows:
   (b) thereupon certify to the  commissioner  of  taxation  and  finance
 those costs that have been determined to be qualifying health care costs
 to be paid from the fund[.]; AND
   (C)  NOTIFY THE QUALIFIED PLAINTIFF WHICH OF SUCH COSTS ARE QUALIFYING
 HEALTH CARE COSTS TO BE PAID FROM THE FUND  ALONG  WITH  WHICH  OF  SUCH
 COSTS ARE NOT QUALIFYING HEALTH CARE COSTS TO BE PAID FROM THE FUND IN A
 REASONABLY PROMPT PERIOD OF TIME.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD04765-01-5
 A. 1936                             2
 
              

   §  3.  Subdivision  5  and  paragraph  (a) of subdivision 6 of section
 2999-i of the public health law, as amended by section 2 of  part  K  of
 chapter 57 of the laws of 2019, are amended to read as follows:
   5. For the state fiscal year beginning April first, two thousand elev-
 en  and ending March thirty-first, two thousand twelve, the state fiscal
 year beginning April first, two thousand twelve and ending  March  thir-
 ty-first,  two  thousand  thirteen,  and the state fiscal year beginning
 April first, two thousand thirteen and ending  March  thirty-first,  two
 thousand  fourteen, the superintendent of financial services shall cause
 to be deposited into the fund for  each  such  fiscal  year  the  amount
 appropriated for such purpose. Beginning April first, two thousand four-
 teen  and  annually thereafter, the superintendent of financial services
 or the commissioner, whoever is administering the fund for the  applica-
 ble  period shall cause to be deposited into the fund, subject to avail-
 able appropriations, an amount  equal  to  the  difference  between  the
 amount appropriated to the fund in the preceding fiscal year[,].  BEGIN-
 NING  APRIL  FIRST,  TWO  THOUSAND  TWENTY-SIX,  THE COMMISSIONER OR THE
 ADMINISTRATOR OF THE FUND FOR THE APPLICABLE PERIOD SHALL  CAUSE  TO  BE
 DEPOSITED  INTO  THE FUND AN AMOUNT EQUAL TO THE FUNDING LEVEL NECESSARY
 TO ENSURE THE LIABILITIES OF THE MEDICAL INDEMNITY FUND DO NOT EQUAL  OR
 EXCEED EIGHTY PERCENT OF THE FUND'S ASSETS AS DETERMINED IN THE ACTUARI-
 AL  CALCULATION  SET  FORTH  IN PARAGRAPH (A) OF SUBDIVISION SIX OF THIS
 SECTION, as increased by the adjustment factor  defined  in  subdivision
 seven  of this section[, and the assets of the fund at the conclusion of
 that fiscal year].
   (a) [Following] NO LATER THAN SIXTY DAYS FOLLOWING the deposit  refer-
 enced  in  subdivision  five  of  this  section,  the commissioner shall
 conduct an actuarial calculation of the  estimated  liabilities  of  the
 fund  for  the  coming  year  resulting  from  the  qualified plaintiffs
 enrolled in the fund AND SHALL ALSO CONDUCT QUARTERLY  ACTUARIAL  CALCU-
 LATIONS. THE DEPARTMENT SHALL PUBLICLY POST ON ITS WEBSITE SUCH ACTUARI-
 AL  CALCULATIONS  WITHIN  THIRTY DAYS OF COMPLETION.   The administrator
 shall from time to time  adjust  such  calculation  in  accordance  with
 subdivision  seven  of  this  section.  If the total of all estimates of
 current liabilities equals or  exceeds  eighty  percent  of  the  fund's
 assets,  then  the fund shall not accept any new enrollments until a new
 deposit has been made pursuant to  subdivision  five  of  this  section,
 PROVIDED HOWEVER, THE DEPARTMENT SHALL PROVIDE SIXTY DAYS' NOTICE ON ITS
 WEBSITE BEFORE THE FUND SUSPENDS ENROLLMENTS.  When, as a result of such
 new  deposit,  the fund's liabilities no longer exceed eighty percent of
 the fund's assets, the fund administrator  shall  enroll  new  qualified
 plaintiffs  in  the  order  that  an application for enrollment has been
 submitted in accordance with subdivision seven  of  section  twenty-nine
 hundred   ninety-nine-j  of  this  title.    NOTWITHSTANDING  ANY  OTHER
 PROVISION OF THIS SECTION, FOR THE STATE  FISCAL  YEAR  BEGINNING  APRIL
 FIRST, TWO THOUSAND TWENTY-FIVE AND ENDING MARCH THIRTY-FIRST, TWO THOU-
 SAND TWENTY-SIX, THE FUND SHALL CONTINUE TO ACCEPT NEW ENROLLMENTS.
   §  4.  This act shall take effect immediately; provided, however, that
 sections one and two of this act shall take effect on the ninetieth  day
 after it shall have become a law.