Bill Text: NY A09835 | 2015-2016 | General Assembly | Amended
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Relates to payments from the New York state medical indemnity fund.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Introduced - Dead) 2016-06-16 - substituted by s7873b [A09835 Detail]
Download: New_York-2015-A09835-Amended.html
Bill Title: Relates to payments from the New York state medical indemnity fund.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Introduced - Dead) 2016-06-16 - substituted by s7873b [A09835 Detail]
Download: New_York-2015-A09835-Amended.html
STATE OF NEW YORK ________________________________________________________________________ 9835--A IN ASSEMBLY April 12, 2016 ___________ Introduced by M. of A. ABINANTI -- read once and referred to the Commit- tee on Health -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the public health law, in relation to payments from the New York state medical indemnity fund The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Section 2999-j of the public health law is amended by 2 adding two new subdivisions 2-a and 7-a to read as follows: 3 2-a. A request for review of a denial of a claim or a denial of a 4 request for prior authorization for the payment or reimbursement from 5 the fund for qualifying health care costs must be made by the claimant 6 no later than sixty days from receipt of the denial and, at a claimant's 7 option, by either (a) making application to the court wherein the judge- 8 ment was awarded or the case was settled, or (b) following the process 9 established by regulations of the commissioner for the administrative 10 review of a denial of a claim or request for prior authorization. 11 7-a. A request for a review of a determination by the fund administra- 12 tor that the relevant provisions of subdivision six of this section have 13 not been met and/or that the plaintiff or claimant is not a qualified 14 plaintiff may be made by any of the parties, no later than sixty days 15 from receipt of the denial, by making application to the court wherein 16 the judgment was awarded or the case was settled. 17 § 2. Subdivisions 2 and 4 of section 2999-j of the public health law, 18 as added by section 52 of part H of chapter 59 of the laws of 2011, are 19 amended to read as follows: 20 2. The provision of qualifying health care costs to qualified plain- 21 tiffs shall not be subject to prior authorization, except as described 22 by the commissioner in regulation; provided, however[, that]: 23 (a) such regulation shall not prevent qualified plaintiffs from 24 receiving care or assistance that would, at a minimum, be authorized 25 under the medicaid program; [and provided, further, that] 26 (b) if any prior authorization is required by such regulation, the 27 regulation shall require that requests for prior authorization be proc- 28 essed within a reasonably prompt period of time and, subject to the 29 provisions of subdivision two-a of this section, shall identify a proc- EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD14645-08-6A. 9835--A 2 1 ess for prompt administrative review of any denial of a request for 2 prior authorization[.]; and 3 (c) such regulations shall not prohibit qualifying health care costs 4 solely on the basis that the qualifying health care cost is therapeutic 5 in nature or on the grounds that the qualifying health care cost is not 6 limited to the direct need of the patient and may benefit other members 7 of the household. 8 4. The amount of qualifying health care costs to be paid from the fund 9 shall be calculated[: (a) with respect to services provided in private10physician practices on the basis of one hundred percent of the usual and11customary rates,] on the basis of one hundred percent of the usual and 12 customary cost. For the purposes of this section, "usual and customary 13 costs" shall mean the eightieth percentile of all charges for the 14 particular health care service performed by a provider in the same or 15 similar specialty and provided in the same geographical area as reported 16 in a benchmarking database maintained by a nonprofit organization speci- 17 fied by the superintendent of financial services. If no such rates are 18 available qualifying health care costs shall be calculated on the basis 19 of no less than one hundred thirty percent of Medicaid or Medicare rates 20 of reimbursement, whichever is higher. If no such rate exists, costs 21 shall be reimbursed as defined by the commissioner in regulation[; or22(b) with respect to all other services, on the basis of Medicaid rates23of reimbursement or, where no such rates are available, as defined by24the commissioner in regulation]. 25 § 3. Subdivision 1 of section 2999-h of the public health law, as 26 added by section 52 of part H of chapter 59 of the laws of 2011, is 27 amended to read as follows: 28 1. "Birth-related neurological injury" means an injury to the brain or 29 spinal cord of a live infant caused by the deprivation of oxygen or 30 mechanical injury occurring in the course of labor, delivery or resusci- 31 tation or by other medical services provided or not provided during 32 delivery [admission] that rendered the infant with a permanent and 33 substantial motor impairment or with a developmental disability as that 34 term is defined by section 1.03 of the mental hygiene law, or both. This 35 definition shall apply to live births only. 36 § 4. The public health law is amended by adding a new section 2999-k 37 to read as follows: 38 § 2999-k. Consumer and stakeholder workgroup. The department shall 39 convene a workgroup comprised of qualified plaintiffs or representatives 40 of qualified plaintiffs, physicians, advocates and other interested 41 parties. Such workgroup shall be co-chaired by the commissioner and the 42 superintendent of financial services, and shall be composed of not less 43 than nine members appointed by the governor, of which two shall be 44 appointed upon recommendation of the temporary president of the senate 45 and two shall be appointed upon the recommendation of the speaker of the 46 assembly. If the commissioner seeks to promulgate rules and regulations 47 pursuant to this title, he or she shall submit the proposed rules and 48 regulations to the workgroup for its input and comments. The commission- 49 er shall consider the input and comments of the workgroup prior to the 50 implementation of any proposed rule or regulation, and if he or she 51 shall act in a manner inconsistent with the workgroup's input and 52 comments, the commissioner shall provide the reasons therefor in writ- 53 ing. 54 § 5. This act shall take effect on the forty-fifth day after it shall 55 have become a law.
