Bill Text: NY S07873 | 2015-2016 | General Assembly | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Relates to payments from the New York state medical indemnity fund.

Spectrum: Bipartisan Bill

Status: (Passed) 2016-12-31 - SIGNED CHAP.517 [S07873 Detail]

Download: New_York-2015-S07873-Amended.html

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                STATE OF NEW YORK
        ________________________________________________________________________
                                         7873--A
            Cal. No. 1401
                    IN SENATE
                                      May 19, 2016
                                       ___________
        Introduced  by Sens. HANNON, CARLUCCI, KRUEGER -- read twice and ordered
          printed, and when printed to be committed to the Committee  on  Health
          -- reported favorably from said committee and committed to the Commit-
          tee  on  Finance -- reported favorably from said committee, ordered to
          first report, amended on first report, ordered to a second report  and
          ordered reprinted, retaining its place in the order of second report
        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]:
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD14645-11-6
        S. 7873--A                          2
     1    (a) such  regulation  shall  not  prevent  qualified  plaintiffs  from
     2  receiving  care  or  assistance  that would, at a minimum, be authorized
     3  under the medicaid program; [and provided, further, that]
     4    (b)  if  any  prior  authorization is required by such regulation, the
     5  regulation shall require that requests for prior authorization be  proc-
     6  essed  within  a  reasonably  prompt  period of time and, subject to the
     7  provisions of subdivision two-a of this section, shall identify a  proc-
     8  ess  for  prompt  administrative  review  of any denial of a request for
     9  prior authorization[.]; and
    10    (c) such regulations shall not prohibit qualifying health  care  costs
    11  solely  on the basis that the qualifying health care cost is therapeutic
    12  in nature or on the grounds that the qualifying health care cost is  not
    13  limited  to the direct need of the patient and may benefit other members
    14  of the household.
    15    4. The amount of qualifying health care costs to be paid from the fund
    16  shall be calculated[: (a) with respect to services provided  in  private
    17  physician practices on the basis of one hundred percent of the usual and
    18  customary  rates,]  on the basis of one hundred percent of the usual and
    19  customary cost. For the purposes of this section, "usual  and  customary
    20  costs"  shall  mean  the  eightieth  percentile  of  all charges for the
    21  particular health care service performed by a provider in  the  same  or
    22  similar specialty and provided in the same geographical area as reported
    23  in a benchmarking database maintained by a nonprofit organization speci-
    24  fied  by  the superintendent of financial services. If no such rates are
    25  available qualifying health care costs shall be calculated on the  basis
    26  of no less than one hundred thirty percent of Medicaid or Medicare rates
    27  of  reimbursement,  whichever  is  higher. If no such rate exists, costs
    28  shall be reimbursed as defined by the commissioner  in  regulation[;  or
    29  (b)  with  respect to all other services, on the basis of Medicaid rates
    30  of reimbursement or, where no such rates are available,  as  defined  by
    31  the commissioner in regulation].
    32    §  3.  Subdivision  1  of  section 2999-h of the public health law, as
    33  added by section 52 of part H of chapter 59 of  the  laws  of  2011,  is
    34  amended to read as follows:
    35    1. "Birth-related neurological injury" means an injury to the brain or
    36  spinal  cord  of  a  live  infant caused by the deprivation of oxygen or
    37  mechanical injury occurring in the course of labor, delivery or resusci-
    38  tation, or by other medical services provided  or  not  provided  during
    39  delivery  admission,  that  rendered  the  infant  with  a permanent and
    40  substantial motor impairment or with a developmental disability as  that
    41  term is defined by section 1.03 of the mental hygiene law, or both. This
    42  definition shall apply to live births only.
    43    §  4.  The public health law is amended by adding a new section 2999-k
    44  to read as follows:
    45    § 2999-k. Consumer and stakeholder  workgroup.  The  department  shall
    46  convene a workgroup comprised of qualified plaintiffs or representatives
    47  of  qualified  plaintiffs,  physicians,  advocates  and other interested
    48  parties. Such workgroup shall be co-chaired by the commissioner and  the
    49  superintendent  of financial services, and shall be composed of not less
    50  than nine members appointed by the  governor,  of  which  two  shall  be
    51  appointed  upon  recommendation of the temporary president of the senate
    52  and two shall be appointed upon the recommendation of the speaker of the
    53  assembly. If the commissioner seeks to promulgate rules and  regulations
    54  pursuant  to  this  title, he or she shall submit the proposed rules and
    55  regulations to the workgroup for its input and comments. The commission-
    56  er shall consider the input and comments of the workgroup prior  to  the
        S. 7873--A                          3
     1  implementation  of  any  proposed  rule  or regulation, and if he or she
     2  shall act in a  manner  inconsistent  with  the  workgroup's  input  and
     3  comments,  the  commissioner shall provide the reasons therefor in writ-
     4  ing.
     5    §  5. This act shall take effect on the forty-fifth day after it shall
     6  have become a law.