Bill S132-2013

Authorizes a pilot program for enhanced prior approval of high cost diagnostic radiology services

Authorizes the commissioner of health, within fiscal year 2013-2014, to contract with high bidders to perform pilot projects to assess the feasibility of reducing medically unnecessary high cost radiological procedures and generalizing cost savings to the state through enhanced medical management and prior review of orders for diagnostic imaging.

Details

Actions

  • Jan 8, 2014: REFERRED TO HEALTH
  • Jan 9, 2013: REFERRED TO HEALTH

Memo

BILL NUMBER:S132

TITLE OF BILL: An act to amend the social services law, in relation to authorizing a pilot program for enhanced prior approval of high cost diagnostic radiology services

PURPOSE OR GENERAL IDEA OF BILL: Use of Radiology Benefit Management (RBM) services to reduce radiology expenses on Medicaid recipients.

The may contract with qualified bidders to access the feasibility of reducing medically unnecessary high cost radiological procedures using selection criteria that includes using entities that utilize and currently utilize only licensed radiologists, and are based in New York.

JUSTIFICATION: Redundant high tech imaging, typically classified as MRI, CTs, and Pet scans, pose a significant concern, as there are few strategies to manage it, while the ramifications of repeat radiation exposure, and the high cost to patients is of great concern.

RBMs have been successful in reducing and containing rising cost and utilization related to diagnostic imaging. The factors that contribute to the growth of these costs are likely to persist because they include an aging population, and advances in diagnostic imaging technology.

PRIOR LEGISLATIVE HISTORY: S..5764 of 2009 06/03/09 Referred to Social Services 07/16/09 Committee Discharged and Committed to Rules 07/16/09 Ordered to Third Reading Cal. 926 07/16/09 Passed Senate 07/16/09 Delivered to Assembly 07/17/09 Referred to Health 01/06/10 Died in Assembly 01/06/10 Returned to Senate 01/06/10 Referred to Social Services 03/04/10 Committee Discharged and Committed to Health S.1550 of 2011 01/10/11 REFERRED TO SOCIAL SERVICES 01/04/12 REFERRED TO SOCIAL SERVICES

FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS: Projected 2009-2010 savings $2.3 million. Projected 2010-2011 savings $5.8 million.

EFFECTIVE DATE: This act shall take effect immediately.


Text

STATE OF NEW YORK ________________________________________________________________________ 132 2013-2014 Regular Sessions IN SENATE (PREFILED) January 9, 2013 ___________
Introduced by Sen. SAMPSON -- read twice and ordered printed, and when printed to be committed to the Committee on Health AN ACT to amend the social services law, in relation to authorizing a pilot program for enhanced prior approval of high cost diagnostic radiology services THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. The social services law is amended by adding a new section 369-gg to read as follows: S 369-GG. PILOT PROGRAM FOR ENHANCED PRIOR APPROVAL OF HIGH COST DIAG- NOSTIC RADIOLOGY SERVICES. 1. PURSUANT TO SECTION ONE HUNDRED SIXTY-THREE OF THE STATE FINANCE LAW, THE COMMISSIONER OF HEALTH SHALL, WITHIN THE FISCAL YEAR OF TWO THOUSAND THIRTEEN--TWO THOUSAND FOURTEEN, CONTRACT WITH QUALIFIED BIDDERS TO PERFORM PILOT PROJECTS TO ASSESS THE FEASIBILITY OF REDUCING MEDICALLY UNNECESSARY HIGH COST RADIOLOGICAL PROCEDURES AND GENERALIZING COST SAVINGS TO THE STATE THROUGH ENHANCED MEDICAL MANAGEMENT AND PRIOR REVIEW OF ORDERS FOR DIAGNOSTIC IMAGING. 2. THE COMMISSIONER OF HEALTH SHALL SELECT AN ENTITY TO PERFORM SUCH PILOT PROJECT UTILIZING THE FOLLOWING SELECTION CRITERIA: (A) THE ENTITY SHALL HAVE AT LEAST ONE YEAR'S EXPERIENCE UTILIZING AND CURRENTLY UTILIZING LICENSED PROFESSIONALS TO CONDUCT INTAKE OF PATIENTS; (B) THE ENTITY SHALL HAVE AT LEAST ONE YEAR'S EXPERIENCE UTILIZING AND CURRENTLY UTILIZING ONLY LICENSED RADIOLOGISTS TO MAKE PRIOR REVIEW DETERMINATIONS; (C) THE ENTITY SHALL HAVE AT LEAST ONE YEAR'S EXPERIENCE UTILIZING AND CURRENTLY UTILIZING LICENSED RADIOLOGISTS TO REQUEST ADDITIONAL INFORMA- TION, AS NECESSARY, FROM THE TREATING PROVIDER; (D) THE ENTITY SHALL BE BASED IN NEW YORK AND AT LEAST FIFTY PERCENT OF THE ENTITY'S EMPLOYEES SHALL RESIDE IN NEW YORK.
S 2. If any clause, sentence, paragraph, section or part of this act shall be adjudged by any court of competent jurisdiction to be invalid, such judgment shall not affect, impair, or invalidate the remainder thereof, but shall be confined in its operation to the clause, sentence, paragraph, section, or part thereof directly involved in the controversy in which such judgment shall have been rendered. S 3. This act shall take effect immediately.

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