Bill Text: NY S07873 | 2015-2016 | General Assembly | Amended
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
STATE OF NEW YORK ________________________________________________________________________ 7873--B Cal. No. 1401 IN SENATE May 19, 2016 ___________ Introduced by Sens. HANNON, CARLUCCI, FUNKE, 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 Committee 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 -- ordered to a third reading, passed by Senate and delivered to the Assembly, recalled, vote reconsidered, restored to third reading, amended and ordered reprinted, retaining its place in the order of third reading 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: EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD14645-14-6S. 7873--B 2 1 2. The provision of qualifying health care costs to qualified plain- 2 tiffs shall not be subject to prior authorization, except as described 3 by the commissioner in regulation; provided, however[, that]: 4 (a) such regulation shall not prevent qualified plaintiffs from 5 receiving care or assistance that would, at a minimum, be authorized 6 under the medicaid program; [and provided, further, that] 7 (b) if any prior authorization is required by such regulation, the 8 regulation shall require that requests for prior authorization be proc- 9 essed within a reasonably prompt period of time and, subject to the 10 provisions of subdivision two-a of this section, shall identify a proc- 11 ess for prompt administrative review of any denial of a request for 12 prior authorization[.]; and 13 (c) such regulations shall not prohibit qualifying health care costs 14 on the grounds that the qualifying health care cost is not limited to 15 the direct need of the patient and may benefit other members of the 16 household. 17 4. The amount of qualifying health care costs to be paid from the fund 18 shall be calculated[: (a) with respect to services provided in private19physician practices on the basis of one hundred percent of the usual and20customary rates,] on the basis of one hundred percent of the usual and 21 customary cost. For the purposes of this section, "usual and customary 22 costs" shall mean the eightieth percentile of all charges for the 23 particular health care service performed by a provider in the same or 24 similar specialty and provided in the same geographical area as reported 25 in a benchmarking database maintained by a nonprofit organization speci- 26 fied by the superintendent of financial services. If no such rates are 27 available qualifying health care costs shall be calculated on the basis 28 of no less than one hundred thirty percent of Medicaid or Medicare rates 29 of reimbursement, whichever is higher. If no such rate exists, costs 30 shall be reimbursed as defined by the commissioner in regulation[; or31(b) with respect to all other services, on the basis of Medicaid rates32of reimbursement or, where no such rates are available, as defined by33the commissioner in regulation]. 34 § 3. Subdivisions 1 and 3 of section 2999-h of the public health law, 35 as added by section 52 of part H of chapter 59 of the laws of 2011, are 36 amended to read as follows: 37 1. "Birth-related neurological injury" means an injury to the brain or 38 spinal cord of a live infant caused by the deprivation of oxygen or 39 mechanical injury occurring in the course of labor, delivery or resusci- 40 tation, or by other medical services provided or not provided during 41 delivery admission, that rendered the infant with a permanent and 42 substantial motor impairment or with a developmental disability as that 43 term is defined by section 1.03 of the mental hygiene law, or both. This 44 definition shall apply to live births only. 45 3. "Qualifying health care costs" means the future medical, hospital, 46 surgical, nursing, dental, rehabilitation, habilitation, respite, custo- 47 dial, durable medical equipment, home modifications, assistive technolo- 48 gy, vehicle modifications, transportation for purposes of health care 49 related appointments, prescription and non-prescription medications, and 50 other health care costs actually incurred for services rendered to and 51 supplies utilized by qualified plaintiffs, which are necessary to meet 52 their health care needs, including providing therapeutic benefit, as 53 determined by their treating physicians, physician assistants, or nurse 54 practitioners and as otherwise defined by the commissioner in regu- 55 lation.S. 7873--B 3 1 § 4. The public health law is amended by adding a new section 2999-k 2 to read as follows: 3 § 2999-k. Consumer and stakeholder workgroup. The department shall 4 convene a workgroup comprised of qualified plaintiffs or representatives 5 of qualified plaintiffs, physicians, advocates and other interested 6 parties. Such workgroup shall be co-chaired by the commissioner and the 7 superintendent of financial services, and shall be composed of not less 8 than nine members appointed by the governor, of which two shall be 9 appointed upon recommendation of the temporary president of the senate 10 and two shall be appointed upon the recommendation of the speaker of the 11 assembly. If the commissioner seeks to make any regulations under this 12 title, he or she shall submit the proposed regulations to the workgroup 13 for its input and comments. The commissioner shall consider the input 14 and comments of the workgroup prior to the adoption of any proposed 15 regulation, and if he or she shall act in a manner inconsistent with the 16 workgroup's input and comments, the commissioner shall provide the 17 reasons therefor in writing. 18 § 5. This act shall take effect on the forty-fifth day after it shall 19 have become a law.
