Bill Text: NY A10301 | 2023-2024 | General Assembly | Amended

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Bill Title: Requires any regulation that mandates prior authorization to establish a mechanism for submission of requests for prior authorization by health care providers directly to the medical indemnity fund; requires the medical indemnity fund administrator to notify qualified plaintiffs which costs are qualifying health care costs to be paid from the fund and which are not within a reasonably prompt period of time.

Spectrum: Partisan Bill (Democrat 3-0)

Status: (Introduced) 2024-05-22 - print number 10301a [A10301 Detail]

Download: New_York-2023-A10301-Amended.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                        10301--A

                   IN ASSEMBLY

                                      May 17, 2024
                                       ___________

        Introduced  by  COMMITTEE  ON  RULES  -- (at request of M. of A. Paulin,
          Sayegh) -- read once and  referred  to  the  Committee  on  Health  --
          reported  and referred to the Committee on Ways and Means -- committee
          discharged, bill amended, ordered reprinted as amended and recommitted
          to said committee

        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:

     1    Section 1. Paragraph (b) of subdivision 2 of  section  2999-j  of  the
     2  public  health  law,  as amended by section 3 of part K of chapter 57 of
     3  the laws of 2019, is amended and a new paragraph (b-1) is added to  read
     4  as follows:
     5    (b)  if  any  prior  authorization is required by such regulation, the
     6  regulation shall require that requests for prior authorization be  proc-
     7  essed  within  a  reasonably  prompt period of time and shall identify a
     8  process for prompt administrative review of any denial of a request  for
     9  prior authorization; [and]
    10    (b-1)  if  any prior authorization is required by such regulation, the
    11  regulation shall require establishing  a  mechanism  for  submission  of
    12  requests  for  prior  authorization by health care providers directly to
    13  the fund; and
    14    § 2. Paragraph (b) of subdivision 8 of section 2999-j  of  the  public
    15  health  law,  as added by section 52 of part H of chapter 59 of the laws
    16  of 2011, is amended and a new paragraph (c) is added to read as follows:
    17    (b) thereupon certify to the  commissioner  of  taxation  and  finance
    18  those costs that have been determined to be qualifying health care costs
    19  to be paid from the fund[.]; and
    20    (c)  notify the qualified plaintiff which of such costs are qualifying
    21  health care costs to be paid from the fund  along  with  which  of  such
    22  costs are not qualifying health care costs to be paid from the fund in a
    23  reasonably prompt period of time.

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD11112-04-4
        A. 10301--A                         2

     1    §  3.  Subdivision  5  and  paragraph  (a) of subdivision 6 of section
     2  2999-i of the public health law, as amended by section 2 of  part  K  of
     3  chapter 57 of the laws of 2019, are amended to read as follows:
     4    5. For the state fiscal year beginning April first, two thousand elev-
     5  en  and ending March thirty-first, two thousand twelve, the state fiscal
     6  year beginning April first, two thousand twelve and ending  March  thir-
     7  ty-first,  two  thousand  thirteen,  and the state fiscal year beginning
     8  April first, two thousand thirteen and ending  March  thirty-first,  two
     9  thousand  fourteen, the superintendent of financial services shall cause
    10  to be deposited into the fund for  each  such  fiscal  year  the  amount
    11  appropriated for such purpose. Beginning April first, two thousand four-
    12  teen  and  annually thereafter, the superintendent of financial services
    13  or the commissioner, whoever is administering the fund for the  applica-
    14  ble  period shall cause to be deposited into the fund, subject to avail-
    15  able appropriations, an amount  equal  to  the  difference  between  the
    16  amount appropriated to the fund in the preceding fiscal year[,].  Begin-
    17  ning  April first, two thousand twenty-five, the commissioner or whoever
    18  is administering the fund for the applicable period shall  cause  to  be
    19  deposited  into  the fund an amount equal to the funding level necessary
    20  to ensure the liabilities of the medical indemnity fund do not equal  or
    21  exceed eighty percent of the fund's assets as determined in the actuari-
    22  al  calculation  set  forth  in paragraph (a) of subdivision six of this
    23  section, as increased by the adjustment factor  defined  in  subdivision
    24  seven  of this section[, and the assets of the fund at the conclusion of
    25  that fiscal year].
    26    (a) [Following] No later than sixty days following the deposit  refer-
    27  enced  in  subdivision  five  of  this  section,  the commissioner shall
    28  conduct an actuarial calculation of the  estimated  liabilities  of  the
    29  fund  for  the  coming  year  resulting  from  the  qualified plaintiffs
    30  enrolled in the fund and shall also conduct quarterly  actuarial  calcu-
    31  lations. The department shall publicly post on its website such actuari-
    32  al  calculations  within  thirty days of completion.   The administrator
    33  shall from time to time  adjust  such  calculation  in  accordance  with
    34  subdivision  seven  of  this  section.  If the total of all estimates of
    35  current liabilities equals or  exceeds  eighty  percent  of  the  fund's
    36  assets,  then  the fund shall not accept any new enrollments until a new
    37  deposit has been made pursuant to  subdivision  five  of  this  section,
    38  provided however, the department shall provide sixty days' notice on its
    39  website before the fund suspends enrollments.  When, as a result of such
    40  new  deposit,  the fund's liabilities no longer exceed eighty percent of
    41  the fund's assets, the fund administrator  shall  enroll  new  qualified
    42  plaintiffs  in  the  order  that  an application for enrollment has been
    43  submitted in accordance with subdivision seven  of  section  twenty-nine
    44  hundred   ninety-nine-j  of  this  title.    Notwithstanding  any  other
    45  provision of this section, for the state  fiscal  year  beginning  April
    46  first, two thousand twenty-four and ending March thirty-first, two thou-
    47  sand twenty-five, the fund shall continue to accept new enrollments.
    48    §  4.  This act shall take effect immediately; provided, however, that
    49  sections one and two of this act shall take effect on the ninetieth  day
    50  after it shall have become a law.