§ 365-d. Medicaid evidence based benefit review advisory committee. 1.
The department shall convene a Medicaid evidence based benefit review
advisory committee. The committee shall provide advice and make
recommendations regarding coverage of health technology or service for
purposes of the medical assistance program. The commissioner shall
consult such committee prior to any determination made regarding the
coverage status of a particular item, health technology or service based
on procedures established in subdivision five of this section under the
medical assistance program. For purposes of this section, "health
technology" means medical devices and surgical procedures used in the
prevention, diagnosis and treatment of disease and other medical
conditions. For purposes of this section "services" means any medical or
behavioral health procedure.

2. (a) The membership of such committee shall, at a minimum, include:

(i) at least three persons licensed and actively engaged in the
practice of medicine in this state;

(ii) one person licensed and actively engaged in the practice of
nursing as a nurse practitioner, or in the practice of midwifery in this
state;

(iii) one person with expertise in health technology assessment or
evidence based medical review who is preferably a health care
professional licensed under title eight of the education law;

(iv) three persons who shall be consumers or representatives of
organizations with a regional or statewide constituency and who have
been involved in activities related to health care consumer advocacy;

(v) one person who is a representative of a hospital organization with
a regional, national or statewide constituency;

(vi) one person who is a representative of a health insurance or
managed care organization with a regional, statewide or national
constituency;

(vii) one person who is a health economist;

(viii) one person with health care expertise who is appointed by the
temporary president of the senate;

(ix) one person with health care expertise who is appointed by the
speaker of the assembly;

(x) a member of the department who shall act as chairperson as
designated by the commissioner; and

(xi) the committee may invite and consult with scientific, technical,
or clinical experts with demonstrable experience or knowledge of the
technology or medical specialty area under review.

3. The department shall provide video or audio access to all meetings
of such committee through the department's website.

4. The members of the committee shall receive no compensation for
their services but shall be reimbursed for expenses actually and
necessarily incurred in the performance of their duties unless expressly
stated otherwise in this section, members shall be appointed by the
commissioner. Members shall serve three year terms, and may be
reappointed for subsequent terms. Committee members shall be deemed to
be employees of the department for purposes of section seventeen of the
public officers law, and shall not participate in any matter before the
committee for which a conflict of interest exists.

5. 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
commissioner shall provide members of the committee with any evidence or
information related to the health technology or medical service
assessment 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 technology 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
technologies or services selected for review, the department shall
conduct or commission a systematic evidence-based assessment of the
health technology'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.

6. The commissioner shall provide notice of any coverage
recommendations developed by the committee by making such information
available on the department's website. Such public notice shall include:
a summary of the deliberations of the committee; a summary of the
positions of those making public comments at meetings of the committee
and any safety and health outcomes data submitted by any interested
party; the response of the committee to those comments, if any; the
clinical evidence upon which the committee bases its recommendations;
and the findings and recommendations of the committee including a final
evidence-based systematic assessment.

7. The commissioner shall provide public notice on the department's
website of the committee's recommendation and the department's final
determination, including: the nature of the determination; an analysis
of the impact of the department's determination on the state Medicaid
plan populations and providers; and the projected fiscal impact to the
state Medicaid program.

8. The recommendations of the committee, made pursuant to this
section, shall be based on a review of the evidence presented to the
committee, including the clinical effectiveness, patient outcomes,
impact on at risk and underserved populations, and safety. The committee
shall review previous recommendations of the committee as new evidence
becomes available and permit oral presentations and the submission of
new evidence at any committee meeting. Such review shall occur pursuant
to the procedure established in subdivisions five and six of this
section. The department may alter or revoke the final determination
after such review pursuant to the procedure established in subdivision
seven of this section.

9. The department shall provide administrative support to the
committee.