A08501 Summary:
BILL NO | A08501 |
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SAME AS | SAME AS S08038 |
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SPONSOR | McDonald |
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COSPNSR | |
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MLTSPNSR | |
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Rpld §4902 sub§ (a) ¶14, §4903 sub§ (e-1), amd §§4902 & 4903, Ins L; rpld §4902 sub 1 ¶(1), §4903 sub 5-a, amd §§4902 & 4903, Pub Health L (as proposed in S.2677-A & A.463-A) | |
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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 which includes the clinical review criteria relied upon to make such determination and any applicable alternative prescription drugs subject to the step therapy protocol of the utilization review agent. |
A08501 Actions:
BILL NO | A08501 | |||||||||||||||||||||||||||||||||||||||||||||||||
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01/04/2024 | referred to insurance | |||||||||||||||||||||||||||||||||||||||||||||||||
01/08/2024 | reported | |||||||||||||||||||||||||||||||||||||||||||||||||
01/11/2024 | advanced to third reading cal.214 | |||||||||||||||||||||||||||||||||||||||||||||||||
01/16/2024 | passed assembly | |||||||||||||||||||||||||||||||||||||||||||||||||
01/16/2024 | delivered to senate | |||||||||||||||||||||||||||||||||||||||||||||||||
01/16/2024 | REFERRED TO RULES | |||||||||||||||||||||||||||||||||||||||||||||||||
01/29/2024 | SUBSTITUTED FOR S8038 | |||||||||||||||||||||||||||||||||||||||||||||||||
01/29/2024 | 3RD READING CAL.38 | |||||||||||||||||||||||||||||||||||||||||||||||||
01/29/2024 | PASSED SENATE | |||||||||||||||||||||||||||||||||||||||||||||||||
01/29/2024 | RETURNED TO ASSEMBLY | |||||||||||||||||||||||||||||||||||||||||||||||||
02/07/2024 | delivered to governor | |||||||||||||||||||||||||||||||||||||||||||||||||
02/07/2024 | signed chap.28 |
A08501 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 | ||||||
Stern | Aye | Bendett | Aye | ||||||
Jacobson | Aye | ||||||||
Meeks | Excused | ||||||||
Forrest | Aye | ||||||||
Anderson | Aye | ||||||||
Cruz | Aye | ||||||||
Bores | Aye | ||||||||
Lunsford | Aye | ||||||||
Berger | Aye | ||||||||
Go to top
A08501 Floor Votes:
Yes
Alvarez
Yes ‡
Byrnes
Yes ‡
Fitzpatrick
Yes
Kim
Yes
Palmesano
Yes
Slater
Yes ‡
Anderson
Yes
Carroll
Yes
Flood
Yes
Lavine
Yes
Paulin
Yes
Smith
Yes
Angelino
Yes
Chandler-Waterm
Yes
Forrest
Yes
Lee
Yes
Peoples-Stokes
Yes
Smullen
Yes
Ardila
Yes
Chang
No
Friend
Yes
Lemondes
Yes
Pheffer Amato
Yes
Solages
Yes
Aubry
Yes
Clark
Yes
Gallagher
Yes
Levenberg
Yes
Pirozzolo
Yes
Steck
Yes
Barclay
Yes
Colton
Yes
Gallahan
Yes
Lucas
Yes
Pretlow
Yes
Stern
Yes
Barrett
Yes
Conrad
Yes
Gandolfo
Yes
Lunsford
Yes
Ra
Yes
Stirpe
Yes
Beephan
Yes
Cook
Yes
Gibbs
Yes ‡
Lupardo
Yes
Raga
Yes
Tague
Yes
Bendett
Yes
Cruz
Yes
Giglio JA
Yes
Magnarelli
Yes
Rajkumar
Yes
Tannousis
Yes
Benedetto
Yes
Cunningham
Yes
Giglio JM
Yes
Maher
Yes
Ramos
Yes
Tapia
Yes
Berger
Yes
Curran
Yes
Glick
Yes
Mamdani
Yes
Reilly
Yes
Taylor
Yes
Bichotte Hermel
Yes
Darling
Yes
Gonzalez-Rojas
Yes
Manktelow
Yes
Reyes
Yes
Thiele
Yes
Blankenbush
Yes
Davila
Yes
Goodell
Yes
McDonald
Yes
Rivera
Yes
Vanel
Yes
Blumencranz
Yes
De Los Santos
Yes
Gray
Yes ‡
McDonough
Yes
Rosenthal
Yes
Walker
Yes
Bores
Yes
DeStefano
ER
Gunther
Yes
McGowan
Yes ‡
Rozic
ER
Wallace
Yes
Brabenec
ER
Dickens
Yes
Hawley
Yes
McMahon
Yes
Santabarbara
Yes
Walsh
Yes
Braunstein
Yes
Dilan
ER
Hevesi
Yes
Meeks
Yes
Sayegh
ER
Weinstein
Yes
Bronson
Yes
Dinowitz
Yes
Hunter
Yes
Mikulin
Yes ‡
Seawright
Yes
Weprin
Yes
Brook-Krasny
No
DiPietro
Yes
Hyndman
Yes
Miller
Yes
Septimo
Yes
Williams
Yes
Brown EA
Yes ‡
Durso
Yes
Jackson
Yes
Mitaynes
Yes
Shimsky
Yes
Woerner
Yes
Brown K
Yes
Eachus
Yes
Jacobson
Yes
Morinello
Yes
Shrestha
Yes
Zaccaro
Yes
Burdick
Yes
Eichenstein
Yes
Jean-Pierre
Yes
Norris
Yes ‡
Sillitti
Yes
Zebrowski
ER
Burgos
Yes
Epstein
Yes
Jensen
Yes
Novakhov
Yes
Simon
Yes
Zinerman
ER
Burke
Yes
Fahy
Yes
Jones
ER
O'Donnell
Yes
Simone
Yes
Mr. Speaker
Yes
Buttenschon
Yes
Fall
Yes
Kelles
Yes
Otis
Yes
Simpson
‡ Indicates voting via videoconference
A08501 Memo:
Go to topNEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)   BILL NUMBER: A8501 SPONSOR: McDonald
  TITLE OF BILL: An act to amend the insurance law and the public health law, in relation to adverse determinations related to a step therapy protocol override determination; and to repeal certain provisions of the insurance law and the public health law relating thereto   PURPOSE OR GENERAL IDEA OF BILL: The purpose of this bill is to make amendments to Chapter 735 of the Laws of 2023 requiring enhanced notification requirements for adverse step therapy determinations.   SUMMARY OF PROVISIONS: Sections 1, 3, 5, & 7 repeal duplicative notification requirements for utilization agents. Sections 2, 4, 6 & 8 require notices of an adverse determination related to a step therapy protocol override determination include the clinical review criteria relied upon to make such determination and any applica- ble alternative prescriptions drugs subject to the step therapy proto- col. In addition, such notifications may be provided electronically, including by electronic mail or through the health care plan's member portal and provider portal, and may link to information posted on the website of the health care plan. Section 9 provides the effective date.   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. Chapter 735 of the Laws of 2023 required utilization review-agents issu- ing a notice of an adverse determination regarding a step therapy proto- col override request to include in the notice the reasons for the deter- mination, including clinical rationale, instructions on how to initiate standard, expedited and external appeals and information that includes any applicable alternative medications covered, the clinical review criteria relied upon to make the determination, and any additional necessary information the utilization review agent relied upon to render such decision. This chapter amendment repeals duplicative notification requirements for utilization agents and requires notices of an adverse determination related to a step therapy protocol override determination to include the clinical review criteria relied upon to make such deter- mination and any applicable alternative prescriptions drugs subject to the step therapy protocol. In addition, such notifications may be provided electronically, including by electronic mail or through the health care plan's member portal and provider portal, and may link to information posted on the website of the health care plan.   PRIOR LEGISLATIVE HISTORY: This is a new bill.   FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS: None.   EFFECTIVE DATE: This act shall take effect on the same date and-in the same manner as a chapter of the laws of 2023 amending the insurance law and the public health law relating to requiring notice of adverse step therapy determi- nations, as proposed in legislative bills numbers S. 2677-A and A. 463-A, takes effect.
A08501 Text:
Go to top STATE OF NEW YORK ________________________________________________________________________ 8501 IN ASSEMBLY January 4, 2024 ___________ Introduced by M. of A. McDONALD -- read once and referred to the Commit- tee on Insurance AN ACT to amend the insurance law and the public health law, in relation to adverse determinations related to a step therapy protocol override determination; and to repeal certain provisions of the insurance law and the public health law relating thereto The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Paragraph 14 of subsection (a) of section 4902 of the 2 insurance law, as added by a chapter of the laws of 2023 amending the 3 insurance law and the public health law relating to requiring notice of 4 adverse step therapy determinations, as proposed in legislative bills 5 numbers S. 2677-A and A. 463-A, is REPEALED. 6 § 2. Paragraph 5 of subsection (a) of section 4902 of the insurance 7 law, as added by chapter 705 of the laws of 1996, subparagraph (ii) as 8 amended by chapter 586 of the laws of 1998, is amended to read as 9 follows: 10 (5) (i) Establishment of a written procedure to assure that the notice 11 of an adverse determination includes: 12 [(i)] (A) the reasons for the determination including the clinical 13 rationale, if any; 14 [(ii)] (B) instructions on how to initiate standard and expedited 15 appeals pursuant to section four thousand nine hundred four of this 16 article and an external appeal pursuant to section four thousand nine 17 hundred fourteen of this article; [and18(iii)] (C) notice of the availability, upon request of the insured or 19 the insured's designee, of the clinical review criteria relied upon to 20 make such determination; 21 (D) what, if any, additional necessary information must be provided 22 to, or obtained by, the utilization review agent in order to render a 23 decision on appeal; and 24 (E) for an adverse determination related to a step therapy protocol 25 override determination, information that includes the clinical review 26 criteria relied upon to make such determination and any applicable EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD02500-04-4A. 8501 2 1 alternative prescription drugs subject to the step therapy protocol of 2 the utilization review agent. 3 (ii) A utilization review agent may provide a notice of an adverse 4 determination related to a step therapy protocol override determination 5 electronically pursuant to subsection (i) of section four thousand nine 6 hundred three of this title, including by electronic mail or through the 7 health care plan's member portal and provider portal. An electronic 8 notice of such an adverse determination may meet the requirements of 9 clause (E) of subparagraph (i) of this paragraph by linking to informa- 10 tion posted on the website of the health care plan; 11 § 3. Subsection (e-1) of section 4903 of the insurance law, as added 12 by a chapter of the laws of 2023 amending the insurance law and the 13 public health law relating to requiring notice of adverse step therapy 14 determinations, as proposed in legislative bills numbers S. 2677-A and 15 A. 463-A, is REPEALED. 16 § 4. Subsection (e) of section 4903 of the insurance law, as added by 17 chapter 705 of the laws of 1996, paragraph 2 as amended by chapter 586 18 of the laws of 1998, is amended to read as follows: 19 (e) (1) Notice of an adverse determination made by a utilization 20 review agent shall be in writing and must include: 21 [(1)] (i) the reasons for the determination including the clinical 22 rationale, if any; 23 [(2)] (ii) instructions on how to initiate standard appeals and expe- 24 dited appeals pursuant to section four thousand nine hundred four and an 25 external appeal pursuant to section four thousand nine hundred fourteen 26 of this article; [and27(3)] (iii) notice of the availability, upon request of the insured, or 28 the insured's designee, of the clinical review criteria relied upon to 29 make such determination. Such notice shall also specify what, if any, 30 additional necessary information must be provided to, or obtained by, 31 the utilization review agent in order to render a decision on the 32 appeal; and 33 (iv) for an adverse determination related to a step therapy protocol 34 override request, information that includes the clinical review criteria 35 relied upon to make such determination and any applicable alternative 36 prescription drugs subject to the step therapy protocol of the utiliza- 37 tion review agent. 38 (2) A utilization review agent may provide notice of an adverse deter- 39 mination related to a step therapy protocol override determination elec- 40 tronically pursuant to subsection (i) of this section, including by 41 electronic mail or through the health care plan's member portal and 42 provider portal. An electronic notice of such an adverse determination 43 may meet the requirements of subparagraph (iv) of paragraph one of this 44 subsection by linking to information posted on the website of the health 45 care plan. 46 § 5. Paragraph (l) of subdivision 1 of section 4902 of the public 47 health law, as added by a chapter of the laws of 2023 amending the 48 insurance law and the public health law relating to requiring notice of 49 adverse step therapy determinations, as proposed in legislative bills 50 numbers S. 2677-A and A. 463-A, is REPEALED. 51 § 6. Paragraph (e) of subdivision 1 of section 4902 of the public 52 health law, as added by chapter 705 of the laws of 1996, subparagraph 53 (ii) as amended by chapter 586 of the laws of 1998, is amended to read 54 as follows: 55 (e) (i) Establishment of a written procedure to assure that the notice 56 of an adverse determination includes: [(i)] (1) the reasons for theA. 8501 3 1 determination including the clinical rationale, if any; [(ii)] (2) 2 instructions on how to initiate standard and expedited appeals pursuant 3 to section forty-nine hundred four and an external appeal pursuant to 4 section forty-nine hundred fourteen of this article; [and (iii)] (3) 5 notice of the availability, upon request of the enrollee or the 6 enrollee's designee, of the clinical review criteria relied upon to make 7 such determination; (4) what, if any, additional necessary information 8 must be provided to, or obtained by, the utilization review agent in 9 order to render a decision on an appeal; and (5) for an adverse determi- 10 nation related to a step therapy protocol override determination, infor- 11 mation that includes the clinical review criteria relied upon to make 12 such determination and any applicable alternative prescription drugs 13 subject to the step therapy protocol of the utilization review agent. 14 (ii) A utilization review agent may provide notice of an adverse 15 determination related to a step therapy protocol override determination 16 electronically pursuant to subdivision nine of section forty-nine 17 hundred three of this title, including by electronic mail or through the 18 health care plan's member portal and provider portal. An electronic 19 notice of such an adverse determination may meet the requirements of 20 clause five of subparagraph (i) of this paragraph by linking to informa- 21 tion posted on the website of the health care plan; 22 § 7. Subdivision 5-a of section 4903 of the public health law, as 23 added by a chapter of the laws of 2023 amending the insurance law and 24 the public health law relating to requiring notice of adverse step ther- 25 apy determinations, as proposed in legislative bills numbers S. 2677-A 26 and A. 463-A, is REPEALED. 27 § 8. Subdivision 5 of section 4903 of the public health law, as added 28 by chapter 705 of the laws of 1996, paragraph (b) as amended by chapter 29 586 of the laws of 1998, is amended to read as follows: 30 5. (a) Notice of an adverse determination made by a utilization review 31 agent shall be in writing and must include: 32 [(a)] (i) the reasons for the determination including the clinical 33 rationale, if any; 34 [(b)] (ii) instructions on how to initiate standard and expedited 35 appeals pursuant to section forty-nine hundred four and an external 36 appeal pursuant to section forty-nine hundred fourteen of this article; 37 [and38(c)] (iii) notice of the availability, upon request of the enrollee, 39 or the enrollee's designee, of the clinical review criteria relied upon 40 to make such determination. Such notice shall also specify what, if any, 41 additional necessary information must be provided to, or obtained by, 42 the utilization review agent in order to render a decision on the 43 appeal; and 44 (iv) for an adverse determination related to a step therapy protocol 45 override request, information that includes the clinical review criteria 46 relied upon to make such determination and any applicable alternative 47 prescription drugs subject to the step therapy protocol of the utiliza- 48 tion review agent. 49 (b) A utilization review agent may provide notice of an adverse deter- 50 mination related to a step therapy protocol override determination elec- 51 tronically pursuant to subdivision nine of this section, including by 52 electronic mail or through the health care plan's member portal and 53 provider portal. An electronic notice of such an adverse determination 54 may meet the requirements of subparagraph (iv) of paragraph (a) of this 55 subdivision by linking to information posted on the website of the 56 health care plan.A. 8501 4 1 § 9. This act shall take effect on the same date and in the same 2 manner as a chapter of the laws of 2023 amending the insurance law and 3 the public health law relating to requiring notice of adverse step ther- 4 apy determinations, as proposed in legislative bills numbers S. 2677-A 5 and A. 463-A, takes effect.
A08501 LFIN:
  | NO LFIN |
A08501 Chamber Video/Transcript:
1-16-24 | Video (@ 01:07:34) | Transcript pdf | Transcript html |