NY State Senate Bill 2013-S7369

Senate Bill S7369

2013-2014 Legislative Session

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

download bill text pdf

Archive: Last Bill Status - In Senate Committee Health Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
May 14, 2014	referred to health

2013-S7369 (ACTIVE) - Details

See Assembly Version of this Bill:: A9765
Current Committee:: Senate Health
Law Section:: Public Health Law
Laws Affected:: Amd §4903, Pub Health L; amd §4903, Ins L
Versions Introduced in 2015-2016 Legislative Session:: S4721, A6983

2013-S7369 (ACTIVE) - Summary

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.

2013-S7369 (ACTIVE) - Sponsor 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 requir-
ing 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 Insur-
ance 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 request-
ing 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, physi-
cian 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 stand-
ardized 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.

2013-S7369 (ACTIVE) - Bill Text download pdf

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

                                  7369

                            I N  S E N A T E

                              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

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.

                                                           LBD15117-01-4

S. 7369                             2

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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