Bill Text: NY A09206 | 2021-2022 | General Assembly | Introduced
Bill Title: Requires disclosure, in such form as the superintendent shall require, of non-confidential information regarding step therapy override requests and determinations on a website that is readily accessible to the public.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Introduced - Dead) 2022-02-09 - referred to insurance [A09206 Detail]
Download: New_York-2021-A09206-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 9206 IN ASSEMBLY February 9, 2022 ___________ Introduced by M. of A. McDONALD -- read once and referred to the Commit- tee on Insurance AN ACT to amend the insurance law and the public health law, in relation to enhanced disclosure of step therapy override requests and determi- nations; and to repeal certain provisions of such laws relating there- to The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Section 4903 of the insurance law is amended by adding two 2 new subsections (j) and (k) to read as follows: 3 (j) Each health care plan and utilization review agent shall annually, 4 in such form as the superintendent shall require, report information to 5 the department regarding step therapy override requests and determi- 6 nations. Such reports shall, among other things, separately identify the 7 following information, organized by individual drug name and drug cate- 8 gory and class: 9 (1) The number of step therapy override determination requests 10 received; 11 (2) The type of health care providers or the medical specialties of 12 the health care providers submitting requests; 13 (3) The number of step therapy override determination requests that 14 were initially denied and the reasons for such denials; 15 (4) The number of step therapy override determination requests that 16 were initially approved; and 17 (5) The number of step therapy override determination requests that 18 were reversed on internal appeal. 19 (k) Each health care plan and utilization review agent shall disclose, 20 in such form as the superintendent shall require, non-confidential 21 information regarding step therapy override requests and determinations 22 on a website or web-based tool that is readily accessible to the public. 23 Such disclosure shall, among other things, separately identify the 24 following information, organized by individual drug name and drug cate- 25 gory and class: EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD14461-01-2A. 9206 2 1 (1) The number of step therapy override determination requests 2 received; 3 (2) The type of health care providers or the medical specialties of 4 the health care providers submitting requests; 5 (3) The number of step therapy override determination requests that 6 were initially denied and the reasons for such denials; 7 (4) The number of step therapy override determination requests that 8 were initially approved; and 9 (5) The number of step therapy override determination requests that 10 were reversed on internal appeal. 11 § 2. Section 4903 of the public health law is amended by adding two 12 new subdivisions 10 and 11 to read as follows: 13 10. Each health care plan and utilization review agent shall annually, 14 in such form as the commissioner shall require, report information to 15 the department regarding step therapy override determination requests 16 and the outcomes of such requests. Such reports shall, among other 17 things, separately identify the following information, organized by 18 individual drug name and drug category and class: 19 (a) The number of step therapy override determination requests 20 received; 21 (b) The type of health care providers or the medical specialties of 22 the health care providers submitting requests; 23 (c) The number of step therapy override determination requests that 24 were initially denied and the reasons for such denials; 25 (d) The number of step therapy override determination requests that 26 were initially approved; and 27 (e) The number of step therapy override determination requests that 28 were reversed on internal appeal. 29 11. Each health care plan and utilization review agent shall disclose, 30 in such form as the commissioner shall require, non-confidential infor- 31 mation regarding step therapy override requests and determinations on a 32 website or web-based tool that is readily accessible to the public. 33 Such disclosure shall, among other things, separately identify the 34 following information, organized by individual drug name and drug cate- 35 gory and class: 36 (a) The number of step therapy override determination requests 37 received; 38 (b) The type of health care providers or the medical specialties of 39 the health care providers submitting requests; 40 (c) The number of step therapy override determination requests that 41 were initially denied and the reasons for such denials; 42 (d) The number of step therapy override determination requests that 43 were initially approved; and 44 (e) The number of step therapy override determination requests that 45 were reversed on internal appeal. 46 § 3. Paragraph 10 of subsection (b) of section 3217-a of the insurance 47 law is REPEALED and three new subsections (g), (h) and (i) are added to 48 read as follows: 49 (g) Where applicable, each insurer subject to this article shall 50 disclose information on step therapy protocols, step therapy override 51 determinations, and internal and external appeals, as governed by arti- 52 cle forty-nine of this chapter, and any associated clinical review 53 criteria pertaining to specific conditions and diseases. Such informa- 54 tion shall be made readily accessible on the insurer's website or web- 55 based tool and, upon request, in written or electronic form to an 56 insured or an insured's authorized representative and a health careA. 9206 3 1 professional as defined in subsection (f) of section four thousand nine 2 hundred of this chapter. 3 (h) If an insurer subject to this article intends either to implement 4 a new requirement or restriction or amend an existing requirement or 5 restriction, relating to a step therapy protocol, internal or external 6 step therapy appeals protocol, or associated clinical review criteria, 7 such insurer shall ensure that such new or amended requirement or 8 restriction is not implemented unless such insurer's website or web- 9 based tool has been updated to reflect such new or amended requirement 10 or restriction. 11 (i) If an insurer subject to this article intends either to implement 12 a new requirement or restriction, or amend an existing requirement or 13 restriction, relating to a step therapy protocol, internal or external 14 step therapy appeals protocol, or associated clinical review criteria, 15 such insurer shall provide any insured or health care professional as 16 defined in subsection (f) of section four thousand nine hundred of this 17 chapter who may be impacted by such new requirement, restriction, or 18 amendment with written notice of such new requirement, restriction, or 19 amendment no less than sixty days before implementation. Such notice may 20 be delivered electronically or by other means. 21 § 4. Paragraph 10 of subsection (b) of section 4324 of the insurance 22 law is REPEALED and three new subsections (g), (h) and (i) are added to 23 read as follows: 24 (g) Where applicable, each health service, hospital service, or 25 medical indemnity corporation subject to this article shall disclose 26 information on step therapy protocols, step therapy override determi- 27 nations, and internal and external appeals, as governed by article 28 forty-nine of this chapter, and any associated clinical review criteria 29 pertaining to specific conditions and diseases. Such information shall 30 be made readily accessible on such health service, hospital service, or 31 medical indemnity corporation's website or web-based tool and, upon 32 request, in written or electronic form to an insured or the insured's 33 authorized representative and a health care professional as defined in 34 subsection (f) of section four thousand nine hundred of this chapter. 35 (h) If a health service, hospital service, or medical indemnity corpo- 36 ration subject to this article intends either to implement a new 37 requirement or restriction or amend an existing requirement or 38 restriction, relating to a step therapy protocol, internal or external 39 step therapy appeals protocol, or associated clinical review criteria, 40 such health service, hospital service, or medical indemnity corporation 41 shall ensure that such new or amended requirement or restriction is not 42 implemented unless such health service, hospital service, or medical 43 indemnity corporation's website or web-based tool has been updated to 44 reflect such new or amended requirement or restriction. 45 (i) If a health service, hospital service, or medical indemnity corpo- 46 ration subject to this article intends either to implement a new 47 requirement or restriction or amend an existing requirement or 48 restriction, relating to a step therapy protocol, internal or external 49 step therapy appeals protocol, or associated clinical review criteria, 50 such health service, hospital service, or medical indemnity corporation 51 shall provide any insured or health care professional as defined in 52 subsection (f) of section four thousand nine hundred of this chapter who 53 may be impacted by such new requirement, restriction, or amendment with 54 written notice of such new requirement, restriction, or amendment no 55 less than sixty days before implementation. Such notice may be delivered 56 electronically or by other means.A. 9206 4 1 § 5. Paragraph (j) of subdivision 2 of section 4408 of the public 2 health law is REPEALED and three new subdivisions 8, 9 and 10 and are 3 added to read as follows: 4 8. Where applicable, each health maintenance organization subject to 5 this article shall disclose information on step therapy protocols, step 6 therapy override determinations, and internal and external appeals, as 7 governed by article forty-nine of this chapter, and any associated clin- 8 ical review criteria pertaining to specific conditions and diseases. 9 Such information shall be made readily accessible on such health mainte- 10 nance organization's website or web-based tool and, upon request, in 11 written or electronic form to an enrollee or the enrollee's authorized 12 representative and a health care professional as defined in subsection 13 (f) of section four thousand nine hundred of this chapter. 14 9. If a health maintenance organization subject to this article 15 intends either to implement a new requirement or restriction or amend an 16 existing requirement or restriction, relating to a step therapy proto- 17 col, internal or external step therapy appeals protocol, or associated 18 clinical review criteria, such health maintenance organization shall 19 ensure that such new or amended requirement or restriction is not imple- 20 mented unless such health maintenance organization's website or web- 21 based tool has been updated to reflect such new or amended requirement 22 or restriction. 23 10. If a health maintenance organization subject to this article 24 intends either to implement a new requirement or restriction or amend an 25 existing requirement or restriction, relating to a step therapy proto- 26 col, internal or external step therapy appeals protocol, or associated 27 clinical review criteria, such health maintenance organization shall 28 provide any enrollee or health care professional as defined in 29 subsection (f) of section four thousand nine hundred of this chapter who 30 may be impacted by such new requirement, restriction, or amendment with 31 written notice of such new requirement, restriction, or amendment no 32 less than sixty days before implementation. Such notice may be delivered 33 electronically or by other means. 34 § 6. This act shall take effect immediately.
