A00463 Summary:
BILL NO | A00463A |
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SAME AS | SAME AS S02677-A |
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SPONSOR | McDonald |
  | |
COSPNSR | Steck, Gunther, Stirpe, Brown K, Weprin, Colton, Bendett |
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MLTSPNSR | |
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Amd 4902 & 4903, Ins L; amd 4902 & 4903, Pub Health L | |
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Requires written notice of an adverse determination made by a utilization review agent in relation to a step therapy protocol override determination. |
A00463 Actions:
BILL NO | A00463A | |||||||||||||||||||||||||||||||||||||||||||||||||
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01/09/2023 | referred to insurance | |||||||||||||||||||||||||||||||||||||||||||||||||
05/17/2023 | reported referred to rules | |||||||||||||||||||||||||||||||||||||||||||||||||
05/25/2023 | amend and recommit to rules 463a | |||||||||||||||||||||||||||||||||||||||||||||||||
06/05/2023 | reported | |||||||||||||||||||||||||||||||||||||||||||||||||
06/05/2023 | rules report cal.483 | |||||||||||||||||||||||||||||||||||||||||||||||||
06/05/2023 | ordered to third reading rules cal.483 | |||||||||||||||||||||||||||||||||||||||||||||||||
06/05/2023 | passed assembly | |||||||||||||||||||||||||||||||||||||||||||||||||
06/05/2023 | delivered to senate | |||||||||||||||||||||||||||||||||||||||||||||||||
06/05/2023 | REFERRED TO RULES | |||||||||||||||||||||||||||||||||||||||||||||||||
06/07/2023 | SUBSTITUTED FOR S2677A | |||||||||||||||||||||||||||||||||||||||||||||||||
06/07/2023 | 3RD READING CAL.1179 | |||||||||||||||||||||||||||||||||||||||||||||||||
06/07/2023 | PASSED SENATE | |||||||||||||||||||||||||||||||||||||||||||||||||
06/07/2023 | RETURNED TO ASSEMBLY | |||||||||||||||||||||||||||||||||||||||||||||||||
12/12/2023 | delivered to governor | |||||||||||||||||||||||||||||||||||||||||||||||||
12/22/2023 | signed chap.735 | |||||||||||||||||||||||||||||||||||||||||||||||||
12/22/2023 | approval memo.61 |
A00463 Committee Votes:
Weprin | Aye | Blankenbush | Aye | ||||||
Cook | Aye | Hawley | Aye | ||||||
Pretlow | Aye | Palmesano | Aye | ||||||
Lavine | Aye | Gandolfo | Aye | ||||||
Steck | Aye | Curran | Aye | ||||||
Dilan | Aye | Jensen | Aye | ||||||
Hunter | Aye | Blumencranz | Aye | ||||||
Rosenthal | Aye | Bendett | Aye | ||||||
Stern | Aye | ||||||||
Jacobson | Aye | ||||||||
Meeks | Aye | ||||||||
Forrest | Aye | ||||||||
Anderson | Aye | ||||||||
Cruz | Aye | ||||||||
Bores | Aye | ||||||||
Lunsford | Aye | ||||||||
Heastie | Excused | Barclay | Aye | ||||||
Weinstein | Aye | Hawley | Aye | ||||||
Pretlow | Aye | Giglio | Aye | ||||||
Cook | Aye | Blankenbush | Excused | ||||||
Glick | Aye | Norris | Aye | ||||||
Aubry | Aye | Ra | Aye | ||||||
Dinowitz | Aye | Brabenec | Aye | ||||||
Colton | Aye | Palmesano | Aye | ||||||
Magnarelli | Aye | Reilly | Aye | ||||||
Paulin | Aye | ||||||||
Peoples-Stokes | Aye | ||||||||
Benedetto | Aye | ||||||||
Lavine | Aye | ||||||||
Lupardo | Aye | ||||||||
Zebrowski | Aye | ||||||||
Thiele | Aye | ||||||||
Braunstein | Aye | ||||||||
Dickens | Aye | ||||||||
Davila | Aye | ||||||||
Hyndman | Excused | ||||||||
Rozic | Aye | ||||||||
Bronson | Aye | ||||||||
Go to top
A00463 Floor Votes:
Yes
Alvarez
Yes
Carroll
Yes
Flood
Yes
Kim
Yes
Palmesano
Yes
Simpson
Yes
Anderson
Yes
Chandler-Waterm
ER
Forrest
Yes
Lavine
Yes
Paulin
Yes
Slater
Yes
Angelino
Yes
Chang
Yes
Friend
Yes
Lee
Yes
Peoples-Stokes
Yes
Smith
Yes
Ardila
Yes
Clark
Yes
Gallagher
Yes
Lemondes
Yes
Pheffer Amato
Yes
Smullen
Yes
Aubry
Yes
Colton
Yes
Gallahan
Yes
Levenberg
Yes
Pirozzolo
Yes
Solages
Yes
Barclay
Yes
Conrad
Yes ‡
Gandolfo
Yes
Lucas
Yes
Pretlow
Yes
Steck
Yes
Barrett
Yes
Cook
Yes
Gibbs
Yes
Lunsford
Yes
Ra
Yes
Stern
Yes
Beephan
Yes
Cruz
Yes
Giglio JA
Yes
Lupardo
Yes
Raga
Yes
Stirpe
Yes
Bendett
ER
Cunningham
Yes
Giglio JM
Yes
Magnarelli
Yes
Rajkumar
Yes
Tague
Yes
Benedetto
Yes
Curran
Yes
Glick
Yes
Maher
Yes
Ramos
Yes
Tannousis
Yes
Bichotte Hermel
Yes
Darling
Yes
Gonzalez-Rojas
Yes
Mamdani
Yes
Reilly
Yes
Tapia
Yes
Blankenbush
Yes
Davila
Yes
Goodell
Yes
Manktelow
Yes
Reyes
Yes
Taylor
Yes
Blumencranz
Yes
De Los Santos
Yes
Gray
Yes
McDonald
Yes
Rivera
Yes
Thiele
Yes
Bores
Yes
DeStefano
Yes
Gunther
Yes ‡
McDonough
Yes
Rosenthal D
Yes
Vanel
Yes
Brabenec
Yes
Dickens
Yes
Hawley
Yes
McGowan
Yes
Rosenthal L
Yes
Walker
Yes
Braunstein
Yes
Dilan
Yes
Hevesi
Yes
McMahon
Yes
Rozic
Yes
Wallace
Yes
Bronson
Yes
Dinowitz
Yes
Hunter
ER
Meeks
Yes
Santabarbara
Yes
Walsh
Yes
Brook-Krasny
Yes
DiPietro
Yes ‡
Hyndman
Yes
Mikulin
Yes
Sayegh
Yes
Weinstein
Yes
Brown E
Yes
Durso
Yes
Jackson
Yes
Miller
Yes
Seawright
Yes
Weprin
Yes
Brown K
Yes
Eachus
Yes
Jacobson
Yes
Mitaynes
Yes
Septimo
Yes
Williams
Yes
Burdick
Yes
Eichenstein
Yes
Jean-Pierre
Yes
Morinello
Yes
Shimsky
Yes
Woerner
ER
Burgos
Yes
Epstein
Yes
Jensen
Yes
Norris
Yes
Shrestha
Yes
Zaccaro
Yes
Burke
Yes
Fahy
Yes
Jones
Yes
Novakhov
Yes
Sillitti
Yes
Zebrowski
Yes
Buttenschon
Yes
Fall
Yes
Joyner
ER
O'Donnell
Yes
Simon
Yes
Zinerman
Yes
Byrnes
Yes
Fitzpatrick
Yes
Kelles
Yes
Otis
Yes
Simone
Yes
Mr. Speaker
‡ Indicates voting via videoconference
A00463 Memo:
Go to topNEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)   BILL NUMBER: A463A SPONSOR: McDonald
  TITLE OF BILL: An act to amend the insurance law and the public health law, in relation to requiring notice of adverse step therapy determinations   PURPOSE OR GENERAL IDEA OF BILL: The purpose of the bill is to require and establish a notice of adverse determination related to step therapy protocol determination and to provide information on how the patient or prescribing health profes- sional can appeal said determination.   SUMMARY OF PROVISIONS: Section one amends section 4902 of the insurance law by adding a new paragraph (14) that establishes a procedure for the notice of an adverse determination related to a step therapy protocol override determination request includes certain criteria. The bill explicitly states the request must include the reasons for the determination including the clinical rationale. In addition, it requires instructions on how to initiate standard and expedited appeals. Finally, it requires informa- tion that includes any applicable alternative covered, the clinical review criteria relied upon, and any additional necessary information the utilization review agent relied upon to render such decision. Section two amends section 4903 of the insurance law to require the aforementioned notice of an adverse determination made by a utilization review agent related to a step therapy protocol override determination request. Such notice is required to be made in writing or by electronic means to the insured or their agent and their prescribing healthcare professional. The notice must include the written procedure as required in section one. Section three amends section 4902 of, the public health law with the same required written procedure guidelines as section one. Section four amends, section 4903 of the public health law with the same-notice requirements for enrollees as section two. Section five establishes the effective date, 90 days after it shall become law.   JUSTIFICATION: Sharing information on an adverse determination of a step therapy over- ride request with the patient and prescriber health care professional is important information that will assist next steps in ascertaining appro- priate patient care. This bill establishes a process to hold all enti- ties accountable and provides next steps for patient or prescribing health professional if that step is decided.   PRIOR LEGISLATIVE HISTORY: 2021-2022: A.9265   FISCAL IMPLICATIONS: None   EFFECTIVE DATE: This act shall take effect on the ninetieth day after it shall become law. Effective immediately, the addition, amendment and/or repeal of any rule or regulation necessary for the implementation of this act on its effective date are authorized to be made and completed on or before such effective date.
A00463 Text:
Go to top STATE OF NEW YORK ________________________________________________________________________ 463--A 2023-2024 Regular Sessions IN ASSEMBLY January 9, 2023 ___________ Introduced by M. of A. McDONALD, STECK, GUNTHER, STIRPE, K. BROWN, WEPRIN, COLTON, BENDETT -- read once and referred to the Committee on Insurance -- reported and referred to the Committee on Rules -- Rules Committee discharged, bill amended, ordered reprinted as amended and recommitted to the Committee on Rules AN ACT to amend the insurance law and the public health law, in relation to requiring notice of adverse step therapy determinations The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Subsection (a) of section 4902 of the insurance law is 2 amended by adding a new paragraph 14 to read as follows: 3 (14) Establishment of a written procedure to assure that the notice of 4 an adverse determination in relation to a step therapy protocol override 5 determination request includes: 6 (i) the reasons for the determination including the clinical ration- 7 ale, if any; 8 (ii) instructions on how to initiate standard and expedited appeals 9 pursuant to section four thousand nine hundred four of this article and 10 an external appeal pursuant to section four thousand nine hundred four- 11 teen of this article; 12 (iii) information that includes: any applicable alternative covered 13 medications; the clinical review criteria relied upon to make such 14 determination; and any additional necessary information that must be 15 provided to, or obtained by, the utilization review agent in order to 16 render a decision on the appeal; 17 (iv) the provisions of this section shall be satisfied by making such 18 information available electronically on a formulary website, on the 19 member portal and/or provider portal of the insurer's, the health main- 20 tenance organization's website, or the website of an organization 21 subject to article forty-three of this chapter, provided that the member 22 consents to receiving the information electronically. EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD02500-03-3A. 463--A 2 1 § 2. Section 4903 of the insurance law is amended by adding a new 2 subsection (e-1) to read as follows: 3 (e-1) Notice of an adverse determination made by a utilization review 4 agent in relation to a step therapy protocol override determination 5 request shall be made in writing to the insured or the insured's author- 6 ized representative and the insured's prescribing health care profes- 7 sional as defined in subsection (f) of section forty-nine hundred of 8 this chapter, and shall include: 9 (i) the reasons for the determination including the clinical ration- 10 ale, if any; 11 (ii) instructions on how to initiate standard and expedited appeals 12 pursuant to section four thousand nine hundred four of this article and 13 an external appeal pursuant to section four thousand nine hundred four- 14 teen of this article; 15 (iii) information that includes: any applicable alternative covered 16 medications; the clinical review criteria relied upon to make such 17 determination; and any additional necessary information that must be 18 provided to, or obtained by, the utilization review agent in order to 19 render a decision on the appeal; 20 (iv) the provisions of this section shall be satisfied by making such 21 information available electronically on a formulary website, on the 22 member portal and/or provider portal of the insurer's, the health main- 23 tenance organization's website, or the website of an organization 24 subject to article forty-three of this chapter, provided that the member 25 consents to receiving the information electronically. 26 § 3. Subdivision 1 of section 4902 of the public health law is amended 27 by adding a new paragraph (l) to read as follows: 28 (l) Establishment of a written procedure to assure that the notice of 29 an adverse determination in relation to a step therapy protocol override 30 determination request includes: (i) the reasons for the determination 31 including the clinical rationale, if any; (ii) instructions on how to 32 initiate standard and expedited appeals pursuant to subdivision two of 33 section forty-nine hundred four of this title and an external appeal 34 pursuant to section forty-nine hundred fourteen of this article; (iii) 35 information that includes: any applicable alternative covered medica- 36 tions; the clinical review criteria relied upon to make such determi- 37 nation; and any additional necessary information that must be provided 38 to, or obtained by, the utilization review agent in order to render a 39 decision on the appeal; (iv) the provisions of this section shall be 40 satisfied by making such information available electronically on a 41 formulary website, on the member portal and/or provider portal of the 42 insurer's, the health maintenance organization's website, or the website 43 of an organization subject to article forty-three of this chapter, 44 provided that the member consents to receiving the information electron- 45 ically. 46 § 4. Section 4903 of the public health law is amended by adding a new 47 subdivision 5-a to read as follows: 48 5-a. Notice of an adverse determination made by a utilization review 49 agent in relation to a step therapy protocol override determination 50 request shall be made in writing to the enrollee or the enrollee's 51 authorized representative and the enrollee's prescribing health care 52 professional as defined in subdivision six of section forty-nine hundred 53 of this title, and shall include: 54 (a) the reasons for the determination including the clinical ration- 55 ale, if any;A. 463--A 3 1 (b) instructions on how to initiate standard and expedited appeals 2 pursuant to section forty-nine hundred four of this title and an 3 external appeal pursuant to section forty-nine hundred fourteen of this 4 article; 5 (c) information that includes: any applicable alternative covered 6 medications; the clinical review criteria relied upon to make such 7 determination; and any additional necessary information that must be 8 provided to, or obtained by, the utilization review agent in order to 9 render a decision on the appeal; 10 (d) the provisions of this section shall be satisfied by making such 11 information available electronically on a formulary website, on the 12 member portal and/or provider portal of the insurer's, the health main- 13 tenance organization's website, or the website of an organization 14 subject to article forty-three of this chapter, provided that the member 15 consents to receiving the information electronically. 16 § 5. This act shall take effect on the ninetieth day after it shall 17 have become a law. Effective immediately, the addition, amendment and/or 18 repeal of any rule or regulation necessary for the implementation of 19 this act on its effective date are authorized to be made and completed 20 on or before such effective date.
A00463 LFIN:
  | NO LFIN |
A00463 Chamber Video/Transcript:
6-5-23 | Video (@ 01:34:27) | Transcript pdf | Transcript html |