Directs the commissioner of health to develop a standard prior prescription drug authorization form for managed care providers.
TITLE OF BILL: An act to amend the social services law, in relation to directing the commissioner of health to develop a standard prior prescription drug authorization request form for managed care providers
PURPOSE: This bill directs the Department of Health to develop a standard prior authorization request form or forms for prescription drug benefits within Medicaid Managed Care.
SUMMARY OF PROVISIONS: The bill would add new subdivision 26 of section 364-j of the social services law, which would direct the Department of Health to develop a standard prior authorization request form or forms to be used by Medicaid managed care providers to determine coverage of prescription drug benefits.
JUSTIFICATION: The 2011-12 New York State Budget, as part of a comprehensive redesign of the Medicaid program, moved the overwhelming majority of prescription drug coverage from the Medicaid fee-for-service program into Medicaid Managed Care. As a result of this change, health care providers now have more than twenty formularies and prior authorization processes to contend with when writing prescriptions for their Medicaid patients. Navigating this system has proven to be a significant administrative burden for health care providers who are already stretched thin when providing critical safety net services to New York's most vulnerable populations.
This bill directs the Department of Health to develop a standard form or forms to be used for prior authorizations related to the prescription drug benefit within Medicaid Managed Care. By standardizing this process, health care providers will be relieved of a substantial administrative burden and will be better able to spend their time caring for patients.
LEGISLATIVE HISTORY: New bill.
FISCAL IMPLICATIONS: None.
EFFECTIVE DATE: Immediately.
STATE OF NEW YORK ________________________________________________________________________ 7384--A IN SENATE May 2, 2012 ___________Introduced by Sens. HANNON, LARKIN -- 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 Rules -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the social services law, in relation to directing the commissioner of health to develop a standard prior prescription drug authorization request form for managed care providers THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Section 364-j of the social services law is amended by adding a new subdivision 26 to read as follows: 26. THE COMMISSIONER OF HEALTH SHALL DEVELOP A STANDARD PRIOR AUTHORI- ZATION REQUEST FORM OR FORMS TO BE UTILIZED BY ALL MANAGED CARE PROVID- ERS FOR PURPOSES OF SUBMITTING A REQUEST FOR A UTILIZATION REVIEW DETER- MINATION FOR COVERAGE OF PRESCRIPTION DRUG BENEFITS UNDER THIS TITLE. THE MANAGED CARE PROVIDER SHALL MAKE THE STANDARD PRIOR AUTHORIZATION REQUEST FORM OR FORMS AVAILABLE TO, AND SHALL ACCEPT IT OR THEM FROM, PRESCRIBING PROVIDERS IN PAPER AND ELECTRONIC FORM. S 2. This act shall take effect immediately; provided, however, that the amendment to section 364-j of the social services law, made by section one of this act shall not affect the repeal of such section and shall be deemed repealed therewith.EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD15724-03-2