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

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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--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.
                                                                   LBD14645-14-6
        S. 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 private
    19  physician practices on the basis of one hundred percent of the usual and
    20  customary 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[; or
    31  (b) with respect to all other services, on the basis of  Medicaid  rates
    32  of  reimbursement  or,  where no such rates are available, as defined by
    33  the 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.