S07873 Summary:

BILL NOS07873B
 
SAME ASSAME AS A09835-B
 
SPONSORHANNON
 
COSPNSRCARLUCCI, FUNKE, KRUEGER
 
MLTSPNSR
 
Amd §§2999-j & 2999-h, add §2999-k, Pub Health L
 
Relates to payments from the New York state medical indemnity fund.
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S07873 Actions:

BILL NOS07873B
 
05/19/2016REFERRED TO HEALTH
05/24/2016REPORTED AND COMMITTED TO FINANCE
06/02/20161ST REPORT CAL.1401
06/06/2016AMENDED 7873A
06/06/20162ND REPORT CAL.
06/07/2016ADVANCED TO THIRD READING
06/09/2016PASSED SENATE
06/09/2016DELIVERED TO ASSEMBLY
06/09/2016referred to health
06/09/2016RECALLED FROM ASSEMBLY
06/09/2016returned to senate
06/09/2016VOTE RECONSIDERED - RESTORED TO THIRD READING
06/09/2016AMENDED ON THIRD READING 7873B
06/14/2016REPASSED SENATE
06/14/2016RETURNED TO ASSEMBLY
06/14/2016referred to codes
06/16/2016substituted for a9835b
06/16/2016ordered to third reading rules cal.451
06/16/2016passed assembly
06/16/2016returned to senate
12/20/2016DELIVERED TO GOVERNOR
12/31/2016APPROVAL MEMO.33
12/31/2016SIGNED CHAP.517
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S07873 Committee Votes:

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S07873 Floor Votes:

DATE:06/16/2016Assembly Vote  YEA/NAY: 142/0
Yes
Abbate
Yes
Crespo
Yes
Gottfried
Yes
Lopez
Yes
Palumbo
Yes
Simon
Yes
Abinanti
Yes
Crouch
Yes
Graf
Yes
Lupardo
Yes
Paulin
Yes
Simotas
Yes
Arroyo
Yes
Curran
Yes
Gunther
Yes
Lupinacci
Yes
Peoples-Stokes
Yes
Skartados
Yes
Aubry
Yes
Cusick
Yes
Harris
Yes
Magee
Yes
Perry
Yes
Skoufis
Yes
Barclay
Yes
Cymbrowitz
Yes
Hawley
Yes
Magnarelli
Yes
Pichardo
Yes
Solages
Yes
Barrett
Yes
Davila
Yes
Hevesi
Yes
Malliotakis
Yes
Pretlow
Yes
Stec
Yes
Barron
Yes
DenDekker
Yes
Hikind
Yes
Markey
Yes
Quart
Yes
Steck
Yes
Benedetto
Yes
Dilan
Yes
Hooper
Yes
Mayer
Yes
Ra
Yes
Stirpe
Yes
Bichotte
Yes
Dinowitz
Yes
Hunter
Yes
McDonald
Yes
Raia
Yes
Tedisco
Yes
Blake
ER
DiPietro
Yes
Hyndman
Yes
McDonough
Yes
Ramos
Yes
Tenney
Yes
Blankenbush
Yes
Duprey
Yes
Jaffee
Yes
McKevitt
Yes
Richardson
Yes
Thiele
Yes
Brabenec
Yes
Englebright
Yes
Jean-Pierre
Yes
McLaughlin
Yes
Rivera
Yes
Titone
Yes
Braunstein
Yes
Fahy
Yes
Johns
Yes
Miller
Yes
Robinson
Yes
Titus
ER
Brennan
Yes
Farrell
Yes
Joyner
Yes
Montesano
Yes
Rodriguez
Yes
Walker
Yes
Brindisi
ER
Finch
ER
Katz
Yes
Morelle
Yes
Rosenthal
Yes
Walter
Yes
Bronson
Yes
Fitzpatrick
Yes
Kavanagh
Yes
Mosley
Yes
Rozic
Yes
Weinstein
Yes
Buchwald
Yes
Friend
Yes
Kearns
Yes
Moya
Yes
Russell
Yes
Weprin
Yes
Butler
Yes
Galef
ER
Kim
Yes
Murray
Yes
Ryan
Yes
Williams
Yes
Cahill
Yes
Gantt
Yes
Kolb
Yes
Nojay
Yes
Saladino
Yes
Woerner
Yes
Cancel
Yes
Garbarino
Yes
Lalor
Yes
Nolan
Yes
Santabarbara
Yes
Wozniak
Yes
Castorina
Yes
Giglio
Yes
Lavine
Yes
Oaks
Yes
Schimel
ER
Wright
Yes
Ceretto
Yes
Gjonaj
Yes
Lawrence
Yes
O'Donnell
Yes
Schimminger
Yes
Zebrowski
Yes
Colton
Yes
Glick
Yes
Lentol
Yes
Ortiz
Yes
Seawright
Yes
Mr. Speaker
Yes
Cook
Yes
Goldfeder
Yes
Lifton
Yes
Otis
Yes
Sepulveda
Yes
Corwin
Yes
Goodell
Yes
Linares
Yes
Palmesano
Yes
Simanowitz

‡ Indicates voting via videoconference
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S07873 Text:



 
                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.
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