Bill S7369-2013

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

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.

Details

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  • May 14, 2014: REFERRED TO HEALTH

Memo

BILL NUMBER:S7369

TITLE OF BILL: 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

PURPOSE:

To reduce the administrative burden on health care providers by requiring greater standardization among insurance companies for the purposes of making prior authorization requests for needed patient treatments.

SUMMARY OF PROVISIONS:

Section 1 of the bill would amend section 4903 of the Public Health Law to require the New York State Department of Health and the New York State Department of Financial Services to develop a standardized form for requesting prior authorization for prescription medications. Once developed, health insurers would be required to accept this form from health care providers seeking prior authorization for necessary prescription medications for their patients.

Section 2 would make corresponding changes to Section 4903 of the Insurance law

JUSTIFICATION:

Chapter 466 of the Laws of 2012 required the Department of Health to create a standardized form for health care providers to use for requesting prior authorization of necessary prescription medications for patients enrolled in Medicaid managed care plans. The form was developed with input from numerous stakeholders and has since been implemented. The goal of the form was to reduce the administrative burden faced by health care providers as a result of moving from a single formulary in the Medicaid fee for service program to the formularies of 20 different insurance companies.

Many physician offices report being overwhelmed by administrative tasks imposed by insurers that take time away from delivering patient care. According to a recent study by the American Medical Association, physician offices spend 20 hours/week on insurer administrative tasks and another study indicated that physician themselves spend, on average, three weeks per year interacting with health plans. Uniform prior authorization would mean prescribers could use the same form for all payers, having clear implications for improved efficiency and enhanced patient outcomes. This legislation would expand the use of this standardized prior authorization request form for patients enrolled in commercial health insurance products.

PRIOR LEGISLATIVE HISTORY:

New bill.

FISCAL IMPLICATIONS:

None.

EFFECTIVE DATE:

This act shall take effect immediately.


Text

STATE OF NEW YORK ________________________________________________________________________ 7369 IN SENATE May 14, 2014 ___________
Introduced by Sen. HANNON -- read twice and ordered printed, and when printed to be committed to the Committee 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: Section 1. Section 4903 of the public health law is amended by adding a new subdivision 8 to read as follows: 8. THE COMMISSIONER, IN CONJUNCTION WITH THE SUPERINTENDENT OF FINAN- CIAL SERVICES, SHALL DEVELOP A STANDARD PRIOR AUTHORIZATION REQUEST FORM TO BE UTILIZED BY ALL HEALTH CARE PLANS FOR THE PURPOSES OF SUBMITTING A REQUEST FOR A UTILIZATION REVIEW DETERMINATION FOR COVERAGE OF PRESCRIPTION DRUG BENEFITS UNDER THIS ARTICLE. THE FORM SHALL BE IDENTI- CAL TO THAT DEVELOPED PURSUANT TO SECTION FOUR THOUSAND NINE HUNDRED THREE OF THE INSURANCE LAW. EACH HEALTH CARE PLAN SHALL MAKE THE STAND- ARD PRIOR AUTHORIZATION REQUEST FORM AVAILABLE TO, AND SHALL ACCEPT IT FROM, PRESCRIBING PROVIDERS IN PAPER AND ELECTRONIC FORM. THE DEPARTMENT AND THE DEPARTMENT OF FINANCIAL SERVICES, IN DEVELOPMENT OF THE STAND- ARDIZED FORM, SHALL TAKE INTO CONSIDERATION EXISTING PRIOR AUTHORIZATION FORMS ESTABLISHED BY THE DEPARTMENT PURSUANT TO SECTION THREE HUNDRED SIXTY-FOUR-J OF THE SOCIAL SERVICES LAW. S 2. Section 4903 of the insurance law is amended by adding a new subsection (h) to read as follows: (H) THE SUPERINTENDENT, IN CONJUNCTION WITH THE COMMISSIONER OF HEALTH, SHALL DEVELOP A STANDARD PRIOR AUTHORIZATION REQUEST FORM TO BE UTILIZED BY ALL HEALTH CARE PLANS FOR THE PURPOSES OF SUBMITTING A REQUEST FOR A UTILIZATION REVIEW DETERMINATION FOR COVERAGE OF PRESCRIPTION DRUG BENEFITS UNDER THIS ARTICLE. THE FORM SHALL BE IDENTI- CAL TO THAT DEVELOPED PURSUANT TO SECTION FORTY-NINE HUNDRED THREE OF THE PUBLIC HEALTH LAW. EACH HEALTH CARE PLAN SHALL MAKE THE STANDARD PRIOR AUTHORIZATION REQUEST FORM AVAILABLE TO, AND SHALL ACCEPT IT FROM, PRESCRIBING PROVIDERS IN PAPER AND ELECTRONIC FORM. THE DEPARTMENT AND THE DEPARTMENT OF HEALTH, IN DEVELOPMENT OF THE STANDARDIZED FORM, SHALL
TAKE INTO CONSIDERATION EXISTING PRIOR AUTHORIZATION FORMS ESTABLISHED BY THE DEPARTMENT OF HEALTH PURSUANT TO SECTION THREE HUNDRED SIXTY-FOUR-J OF THE SOCIAL SERVICES LAW. S 3. This act shall take effect immediately.

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