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A06983 Summary:

BILL NO    A06983 

SAME AS    SAME AS S04721

SPONSOR    McDonald

COSPNSR    

MLTSPNSR   

Amd S4903, Pub Health L; amd S4903, Ins L

Directs the commissioner of health and superintendent of financial services to
establish a standard prior authorization request for a utilization review of
prescription drug coverage.
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A06983 Text:

                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________

                                         6983

                              2015-2016 Regular Sessions

                                 I N  A S S E M B L Y

                                    April 16, 2015
                                      ___________

       Introduced by M. of A. McDONALD -- read once and referred to the Commit-
         tee on Health

       AN ACT to amend the public health law and the insurance law, in relation
         to  a  standard  prior  authorization  request  form for a utilization
         review of prescription drug coverage

         THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
       BLY, DO ENACT AS FOLLOWS:

    1    Section  1. Section 4903 of the public health law is amended by adding
    2  a new subdivision 8 to read as follows:
    3    8. THE COMMISSIONER, IN CONJUNCTION WITH THE SUPERINTENDENT OF  FINAN-
    4  CIAL SERVICES, SHALL DEVELOP A STANDARD PRIOR AUTHORIZATION REQUEST FORM
    5  TO BE UTILIZED BY ALL HEALTH CARE PLANS FOR THE PURPOSES OF SUBMITTING A
    6  REQUEST   FOR   A  UTILIZATION  REVIEW  DETERMINATION  FOR  COVERAGE  OF
    7  PRESCRIPTION DRUG BENEFITS UNDER THIS ARTICLE. THE FORM SHALL BE IDENTI-
    8  CAL TO THAT DEVELOPED PURSUANT TO SECTION  FOUR  THOUSAND  NINE  HUNDRED
    9  THREE  OF THE INSURANCE LAW. EACH HEALTH CARE PLAN SHALL MAKE THE STAND-
   10  ARD PRIOR AUTHORIZATION REQUEST FORM AVAILABLE TO, AND SHALL  ACCEPT  IT
   11  FROM, PRESCRIBING PROVIDERS IN PAPER AND ELECTRONIC FORM. THE DEPARTMENT
   12  AND  THE  DEPARTMENT OF FINANCIAL SERVICES, IN DEVELOPMENT OF THE STAND-
   13  ARDIZED FORM, SHALL TAKE INTO CONSIDERATION EXISTING PRIOR AUTHORIZATION
   14  FORMS ESTABLISHED BY THE DEPARTMENT PURSUANT TO  SECTION  THREE  HUNDRED
   15  SIXTY-FOUR-J OF THE SOCIAL SERVICES LAW.
   16    S  2.  Section  4903  of  the insurance law is amended by adding a new
   17  subsection (h) to read as follows:
   18    (H) THE  SUPERINTENDENT,  IN  CONJUNCTION  WITH  THE  COMMISSIONER  OF
   19  HEALTH,  SHALL DEVELOP A STANDARD PRIOR AUTHORIZATION REQUEST FORM TO BE
   20  UTILIZED BY ALL HEALTH CARE PLANS  FOR  THE  PURPOSES  OF  SUBMITTING  A
   21  REQUEST   FOR   A  UTILIZATION  REVIEW  DETERMINATION  FOR  COVERAGE  OF
   22  PRESCRIPTION DRUG BENEFITS UNDER THIS ARTICLE. THE FORM SHALL BE IDENTI-
   23  CAL TO THAT DEVELOPED PURSUANT TO SECTION FORTY-NINE  HUNDRED  THREE  OF
   24  THE  PUBLIC  HEALTH  LAW.  EACH HEALTH CARE PLAN SHALL MAKE THE STANDARD

        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD04038-01-5
       A. 6983                             2

    1  PRIOR AUTHORIZATION REQUEST FORM AVAILABLE TO, AND SHALL ACCEPT IT FROM,
    2  PRESCRIBING PROVIDERS IN PAPER AND ELECTRONIC FORM. THE  DEPARTMENT  AND
    3  THE DEPARTMENT OF HEALTH, IN DEVELOPMENT OF THE STANDARDIZED FORM, SHALL
    4  TAKE  INTO  CONSIDERATION EXISTING PRIOR AUTHORIZATION FORMS ESTABLISHED
    5  BY  THE  DEPARTMENT  OF  HEALTH  PURSUANT  TO  SECTION   THREE   HUNDRED
    6  SIXTY-FOUR-J OF THE SOCIAL SERVICES LAW.
    7    S 3. This act shall take effect immediately.
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