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.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A1936
SPONSOR: Paulin TITLE OF BILL:
An act to amend the public health law, in relation to prior authori-
zation and payments from the medical indemnity fund
PURPOSE:
To improve and streamline the prior authorization process and general
user experience of the medical indemnity fund and ensure the medical
indemnity fund is properly funded during the 2024-2025 fiscal year and
beyond.
SUMMARY OF PROVISIONS:
Section 1: Amends § 2999-j of the public health law to allow prior
authorization forms to be submitted directly through health care provid-
ers.
Section 2: Requires that a summary of costs be delivered to the quali-
fied plaintiff after claim.
Section 3: Amends § 2999-i(5) to provide that beginning April 1, 2025,
the commissioner shall all deposit an amount equal to the funding level
necessary to ensure the liabilities of the fund do not equal or exceed
eighty percent of the fund's assets as determined by the required actu-
arial calculations. Amends § 2999-i(6)(a) to require the commissioner to
conduct an actuarial calculation of the estimated liabilities of the
fund for the coming year no later than sixty days following the deposit-
ed referenced in subdivision five of this section and require quarterly
actuarial calculations, with the public posting of such actuarial calcu-
lations within thirty days of completion. Requires 60 days' prior notice
of suspension whenever suspension is triggered.
Requires the fund to continue to accept new enrollments during the
fiscal year beginning April 1, 2024 and ending March 31, 2025, provided
the total of all estimates of current liabilities equals or exceeds
ninety percent of the fund's assets.
JUSTIFICATION:
The NYS Medical Indemnity Fund (MIF) is a program designed to provide a
funding source for future health care costs associated with birth
related neurological injuries, in order to reduce premium costs for
medical malpractice insurance coverage. The MIF is currently overseen by
the New York State Department Health (DOH).
This bill will make the Medical Indemnity Fund (MIF) more user friendly,
thus, ensuring that qualified plaintiffs receive what they are owed.
First, this bill would require that the fund administrator accept prior
authorization forms directly from healthcare providers as every other
insurance company does. Second, this bill would also require that for
all claims the claimant is notified what is a qualifying health care
cost that can be paid from the fund. This is to make it easier for the
guardians of qualified plaintiffs to keep track of how much and what
parts of their claims are being paid out of the fund. This bill would
also address the chronic underfunding of the medical indemnity fund that
has recently resulted in the fund being suspended for new enrollments.
It would require the commissioner to deposit enough funding each year,
beginning with the fiscal year beginning April 1, 2025, to ensure the
liabilities of the fund do not equal or exceed eighty percent of the
fund's assets, which is the current trigger for suspension. This is
necessary to ensure the fund remains solvent and able to achieve its
statutory purposes in the future.
Because the fund was suspended approximately two weeks after the
2024-2025 budget was completed, there has been confusion among affected
stakeholders who had no ability to prepare. This bill would keep the
fund open until March 31,2025. The issue can be solved in the SFY25-26
final budget,
LEGISLATIVE HISTORY:
A.10301a of 2024, amended and recommitted to ways and means. Same as
A.7049a, amended and recommitted to health.
FISCAL IMPLICATIONS:
None.
EFFECTIVE DATE:
This act shall take effect immediately; provided however that sections
one and two of this act shall take effect on the ninetieth days after it
shall become a law.
STATE OF NEW YORK
________________________________________________________________________
1936
2025-2026 Regular Sessions
IN ASSEMBLY
January 14, 2025
___________
Introduced by M. of A. PAULIN, SAYEGH, LUCAS -- read once and referred
to the Committee on Health
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
22 costs are not qualifying health care costs to be paid from the fund in a
23 reasonably prompt period of time.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD04765-01-5
A. 1936 2
1 § 3. Subdivision 5 and paragraph (a) of subdivision 6 of section
2 2999-i of the public health law, as amended by section 2 of part K of
3 chapter 57 of the laws of 2019, are amended to read as follows:
4 5. For the state fiscal year beginning April first, two thousand elev-
5 en and ending March thirty-first, two thousand twelve, the state fiscal
6 year beginning April first, two thousand twelve and ending March thir-
7 ty-first, two thousand thirteen, and the state fiscal year beginning
8 April first, two thousand thirteen and ending March thirty-first, two
9 thousand fourteen, the superintendent of financial services shall cause
10 to be deposited into the fund for each such fiscal year the amount
11 appropriated for such purpose. Beginning April first, two thousand four-
12 teen and annually thereafter, the superintendent of financial services
13 or the commissioner, whoever is administering the fund for the applica-
14 ble period shall cause to be deposited into the fund, subject to avail-
15 able appropriations, an amount equal to the difference between the
16 amount appropriated to the fund in the preceding fiscal year[,]. Begin-
17 ning April first, two thousand twenty-six, the commissioner or the
18 administrator of the fund for the applicable period shall cause to be
19 deposited into the fund an amount equal to the funding level necessary
20 to ensure the liabilities of the medical indemnity fund do not equal or
21 exceed eighty percent of the fund's assets as determined in the actuari-
22 al calculation set forth in paragraph (a) of subdivision six of this
23 section, as increased by the adjustment factor defined in subdivision
24 seven of this section[, and the assets of the fund at the conclusion of
25 that fiscal year].
26 (a) [Following] No later than sixty days following the deposit refer-
27 enced in subdivision five of this section, the commissioner shall
28 conduct an actuarial calculation of the estimated liabilities of the
29 fund for the coming year resulting from the qualified plaintiffs
30 enrolled in the fund and shall also conduct quarterly actuarial calcu-
31 lations. The department shall publicly post on its website such actuari-
32 al calculations within thirty days of completion. The administrator
33 shall from time to time adjust such calculation in accordance with
34 subdivision seven of this section. If the total of all estimates of
35 current liabilities equals or exceeds eighty percent of the fund's
36 assets, then the fund shall not accept any new enrollments until a new
37 deposit has been made pursuant to subdivision five of this section,
38 provided however, the department shall provide sixty days' notice on its
39 website before the fund suspends enrollments. When, as a result of such
40 new deposit, the fund's liabilities no longer exceed eighty percent of
41 the fund's assets, the fund administrator shall enroll new qualified
42 plaintiffs in the order that an application for enrollment has been
43 submitted in accordance with subdivision seven of section twenty-nine
44 hundred ninety-nine-j of this title. Notwithstanding any other
45 provision of this section, for the state fiscal year beginning April
46 first, two thousand twenty-five and ending March thirty-first, two thou-
47 sand twenty-six, the fund shall continue to accept new enrollments.
48 § 4. This act shall take effect immediately; provided, however, that
49 sections one and two of this act shall take effect on the ninetieth day
50 after it shall have become a law.
