Bill Text: NY S07049 | 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 2-0)

Status: (Introduced - Dead) 2024-05-23 - PRINT NUMBER 7049A [S07049 Detail]

Download: New_York-2023-S07049-Amended.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                         7049--A

                               2023-2024 Regular Sessions

                    IN SENATE

                                      May 17, 2023
                                       ___________

        Introduced  by  Sen. SKOUFIS -- read twice and ordered printed, and when
          printed to be committed to the Committee on Health --  recommitted  to
          the  Committee  on  Health in accordance with Senate Rule 6, sec. 8 --
          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

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD11112-05-4
        S. 7049--A                          2

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