Bill Text: NY S02800 | 2023-2024 | 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) 2024-01-03 - REFERRED TO INSURANCE [S02800 Detail]
Download: New_York-2023-S02800-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 2800 2023-2024 Regular Sessions IN SENATE January 24, 2023 ___________ Introduced by Sen. BRESLIN -- read twice and ordered printed, and when printed to be committed to the Committee 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 EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD04045-01-3S. 2800 2 1 following information, organized by individual drug name and drug cate- 2 gory and class: 3 (1) The number of step therapy override determination requests 4 received; 5 (2) The type of health care providers or the medical specialties of 6 the health care providers submitting requests; 7 (3) The number of step therapy override determination requests that 8 were initially denied and the reasons for such denials; 9 (4) The number of step therapy override determination requests that 10 were initially approved; and 11 (5) The number of step therapy override determination requests that 12 were reversed on internal appeal. 13 § 2. Section 4903 of the public health law is amended by adding two 14 new subdivisions 10 and 11 to read as follows: 15 10. Each health care plan and utilization review agent shall annually, 16 in such form as the commissioner shall require, report information to 17 the department regarding step therapy override determination requests 18 and the outcomes of such requests. Such reports shall, among other 19 things, separately identify the following information, organized by 20 individual drug name and drug category and class: 21 (a) The number of step therapy override determination requests 22 received; 23 (b) The type of health care providers or the medical specialties of 24 the health care providers submitting requests; 25 (c) The number of step therapy override determination requests that 26 were initially denied and the reasons for such denials; 27 (d) The number of step therapy override determination requests that 28 were initially approved; and 29 (e) The number of step therapy override determination requests that 30 were reversed on internal appeal. 31 11. Each health care plan and utilization review agent shall disclose, 32 in such form as the commissioner shall require, non-confidential infor- 33 mation regarding step therapy override requests and determinations on a 34 website or web-based tool that is readily accessible to the public. 35 Such disclosure shall, among other things, separately identify the 36 following information, organized by individual drug name and drug cate- 37 gory and class: 38 (a) The number of step therapy override determination requests 39 received; 40 (b) The type of health care providers or the medical specialties of 41 the health care providers submitting requests; 42 (c) The number of step therapy override determination requests that 43 were initially denied and the reasons for such denials; 44 (d) The number of step therapy override determination requests that 45 were initially approved; and 46 (e) The number of step therapy override determination requests that 47 were reversed on internal appeal. 48 § 3. Paragraph 10 of subsection (b) of section 3217-a of the insurance 49 law is REPEALED and three new subsections (g), (h) and (i) are added to 50 read as follows: 51 (g) Where applicable, each insurer subject to this article shall 52 disclose information on step therapy protocols, step therapy override 53 determinations, and internal and external appeals, as governed by arti- 54 cle forty-nine of this chapter, and any associated clinical review 55 criteria pertaining to specific conditions and diseases. Such informa- 56 tion shall be made readily accessible on the insurer's website or web-S. 2800 3 1 based tool and, upon request, in written or electronic form to an 2 insured or an insured's authorized representative and a health care 3 professional as defined in subsection (f) of section four thousand nine 4 hundred of this chapter. 5 (h) If an insurer subject to this article intends either to implement 6 a new requirement or restriction or amend an existing requirement or 7 restriction, relating to a step therapy protocol, internal or external 8 step therapy appeals protocol, or associated clinical review criteria, 9 such insurer shall ensure that such new or amended requirement or 10 restriction is not implemented unless such insurer's website or web- 11 based tool has been updated to reflect such new or amended requirement 12 or restriction. 13 (i) If an insurer subject to this article intends either to implement 14 a new requirement or restriction, or amend an existing requirement or 15 restriction, relating to a step therapy protocol, internal or external 16 step therapy appeals protocol, or associated clinical review criteria, 17 such insurer shall provide any insured or health care professional as 18 defined in subsection (f) of section four thousand nine hundred of this 19 chapter who may be impacted by such new requirement, restriction, or 20 amendment with written notice of such new requirement, restriction, or 21 amendment no less than sixty days before implementation. Such notice may 22 be delivered electronically or by other means. 23 § 4. Paragraph 10 of subsection (b) of section 4324 of the insurance 24 law is REPEALED and three new subsections (g), (h) and (i) are added to 25 read as follows: 26 (g) Where applicable, each health service, hospital service, or 27 medical indemnity corporation subject to this article shall disclose 28 information on step therapy protocols, step therapy override determi- 29 nations, and internal and external appeals, as governed by article 30 forty-nine of this chapter, and any associated clinical review criteria 31 pertaining to specific conditions and diseases. Such information shall 32 be made readily accessible on such health service, hospital service, or 33 medical indemnity corporation's website or web-based tool and, upon 34 request, in written or electronic form to an insured or the insured's 35 authorized representative and a health care professional as defined in 36 subsection (f) of section four thousand nine hundred of this chapter. 37 (h) If a health service, hospital service, or medical indemnity corpo- 38 ration subject to this article intends either to implement a new 39 requirement or restriction or amend an existing requirement or 40 restriction, relating to a step therapy protocol, internal or external 41 step therapy appeals protocol, or associated clinical review criteria, 42 such health service, hospital service, or medical indemnity corporation 43 shall ensure that such new or amended requirement or restriction is not 44 implemented unless such health service, hospital service, or medical 45 indemnity corporation's website or web-based tool has been updated to 46 reflect such new or amended requirement or restriction. 47 (i) If a health service, hospital service, or medical indemnity corpo- 48 ration subject to this article intends either to implement a new 49 requirement or restriction or amend an existing requirement or 50 restriction, relating to a step therapy protocol, internal or external 51 step therapy appeals protocol, or associated clinical review criteria, 52 such health service, hospital service, or medical indemnity corporation 53 shall provide any insured or health care professional as defined in 54 subsection (f) of section four thousand nine hundred of this chapter who 55 may be impacted by such new requirement, restriction, or amendment with 56 written notice of such new requirement, restriction, or amendment noS. 2800 4 1 less than sixty days before implementation. Such notice may be delivered 2 electronically or by other means. 3 § 5. Paragraph (j) of subdivision 2 of section 4408 of the public 4 health law is REPEALED and three new subdivisions 9, 10 and 11 are added 5 to read as follows: 6 9. Where applicable, each health maintenance organization subject to 7 this article shall disclose information on step therapy protocols, step 8 therapy override determinations, and internal and external appeals, as 9 governed by article forty-nine of this chapter, and any associated clin- 10 ical review criteria pertaining to specific conditions and diseases. 11 Such information shall be made readily accessible on such health mainte- 12 nance organization's website or web-based tool and, upon request, in 13 written or electronic form to an enrollee or the enrollee's authorized 14 representative and a health care professional as defined in subdivision 15 six of section forty-nine hundred of this chapter. 16 10. If a health maintenance organization subject to this article 17 intends either to implement a new requirement or restriction or amend an 18 existing requirement or restriction, relating to a step therapy proto- 19 col, internal or external step therapy appeals protocol, or associated 20 clinical review criteria, such health maintenance organization shall 21 ensure that such new or amended requirement or restriction is not imple- 22 mented unless such health maintenance organization's website or web- 23 based tool has been updated to reflect such new or amended requirement 24 or restriction. 25 11. If a health maintenance organization subject to this article 26 intends either to implement a new requirement or restriction or amend an 27 existing requirement or restriction, relating to a step therapy proto- 28 col, internal or external step therapy appeals protocol, or associated 29 clinical review criteria, such health maintenance organization shall 30 provide any enrollee or health care professional as defined in subdivi- 31 sion six of section forty-nine hundred of this chapter who may be 32 impacted by such new requirement, restriction, or amendment with written 33 notice of such new requirement, restriction, or amendment no less than 34 sixty days before implementation. Such notice may be delivered electron- 35 ically or by other means. 36 § 6. This act shall take effect immediately.
