What's happening
This bill requires periodic reviews and public reporting of applications for changes in health coverage based on new medical technology or evidence.
Why it matters
Increases transparency and accountability. by requiring the Department of Health to make public the receipt, review schedule, and final reports of applications for changes in health coverage, allowing stakeholders to follow the process and outcomes.
Establishes clear timelines. for each step of the application review process (such as notification of incomplete applications within 30 days, web publication within 7 days, and committee recommendations within 6 months), which may reduce unnecessary delays for patients and providers seeking coverage for new medical technologies.
Gives applicants a defined path to address deficiencies. by mandating that, if an application is found insufficient, the Department must detail the gaps and allow applicants to resubmit, potentially speeding up access to new treatments.
Expands stakeholder engagement and evidence requirements. by mandating public notice, opportunities for oral and written input from interested parties (including patients, providers, and manufacturers), and rigorous, evidence-based assessments before health coverage determinations are made—potentially leading to more informed, equitable decisions about which new technologies are covered.
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Who cares
Headline styles
Review Health Coverage Changes Faster
Plain English, a few words. Used as the page title.
Sponsors
1 Co-sponsor
History
- Referred to health
- Delivered to assembly
- Passed senateVote 59–0
- Advanced to third reading
- 2nd report cal.
- 1st report cal.303
- Referred to health
- Returned to senate
- Died in assembly
- Referred to health
- Delivered to assembly
- Passed senateVote 60–0
Show 4 earlier actions
- Advanced to third reading
- 2nd report cal.
- 1st report cal.486
- Referred to health
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Review Health Coverage Changes
In Assembly Committee · Ways And Means · Sponsor Amy Paulin
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
1225
2025-2026 Regular Sessions
IN SENATE
January 8, 2025
Introduced by Sens. RIVERA, RAMOS -- 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 requiring periodic reviews of pending applications for material change in the coverage status of certain matters relative to new health technology assessment or medical evidence
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Subdivision 5 of section 365-d of the social services law, as added by section 46-a of part B of chapter 57 of the laws of 2015, is amended to read as follows:
5. (a) The commissioner, in consultation with the committee, shall undertake periodic reviews of pending applications for material change in the coverage status of a particular item, health technology or service, and any matter relative to new health technology assessment or medical evidence for which an applicant has submitted a complete application to the department within three months of receipt. The department shall notify an applicant of incompleteness within thirty days of receipt of submission. Receipt of applications shall be published on the department's website within seven days of receipt. The commissioner shall schedule a review of such pending applications and cause publication of the date of review on the department's website within seven days of the review required by this paragraph.
(b) The commissioner, in consultation with the committee, shall issue a report to the chair of the standing committee on health in the senate and assembly and publish the report on the department's website within thirty days of review of any pending application pursuant to paragraph (a) of this subdivision. Such report shall provide the date of application, date of review, and a stated determination of sufficiency of evidence warranting committee deliberation and recommendation. In the event of an affirmative determination of sufficiency of evidence, the
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD03478-01-5
commissioner shall require the committee to issue a recommendation within six months of such determination of sufficiency. In the event of a negative determination, the commissioner shall detail such insufficiency of evidence and allow the applicant to cure stated deficiencies for review under the requirements provided in paragraph (a) of this subdivision.
(c) The committee shall consider any matter regarding material changes in the coverage status of a particular item, health technology or service, and any matter relative to new health technology assessment or medical evidence review for which the department determines a sufficient body of evidence exists to warrant committee deliberation. The commissioner shall provide members of the committee with any evidence or information related to the health technology or medical service assessment including but not limited to, information submitted by members of the public. The department shall report to the committee programmatic changes to benefits that do not rise to the level of a material change, as well as determinations of when sufficient medical evidence exists to warrant committee deliberations. The commissioner shall provide fortyfive days public notice on the department's website prior to any meeting of the committee to develop recommendations concerning health technology or medical service coverage determinations. Such notice shall include a description of the proposed health technology or service to be reviewed, the conditions or diseases impacted by the health technology or service, the proposals to be considered by the committee, and the systematic evidence-based assessment prepared in accordance with this subdivision. The committee shall allow interested parties a reasonable opportunity to make an oral presentation to the committee related to the health technology or service to be reviewed and to submit written information. The committee shall consider any information provided by any interested party, including, but not limited to, health care providers, health care facilities, patients, consumers and manufacturers. For all health technologies or services selected for review, the department shall conduct or commission a systematic evidence-based assessment of the health technology's or service's safety and clinical efficacy. The assessment shall use established systematic review elements, study quality assessment, and data synthesis. Upon completion, the systematic, evidence-based assessment shall be made available to the public.
§ 2. This act shall take effect immediately.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act to amend the social services law, in relation to requiring peri- odic reviews of pending applications for material change in the coverage status of certain matters relative to new health technology assessment or medical evidence
Purpose
Requires periodic reviews of pending applications for material change in the coverage status of certain matters relative to new health technology assessment or medical evidence.
Summary of specific provisions
Section 1 amends subdivision 5 of section 365-d of the social services law as it relates to the Medicaid evidence based benefit review advisory committee, and outlines their review and reporting requirements that the Commissioner of Health, in consultation with the committee, would under- take when reviewing pending applications for material change in the coverage status of a particular item, health technology assessment or services, and anything relative to new health technology assessments.
Section 2 provides the effective date
Justification
In 2015, the Evidence Based Benefits Review Advisory Committee (EBBRAC) was established to accept evidence from providers of services and tech- nologies for the purpose of determining whether Medicaid should cover such services or technologies. The Department of Health (DOH) was authorized to contract with a consultant to review the dossiers submit- ted by provider applicants.
From 2015 through 2017, the vendor selected by the DOH to review provid- er applications was Oregon Health Sciences. In 2017, that vendor's contract was terminated; however, no new vendor has been selected. As EBBRAC is the mandated body to review such applications, the lack of a vendor to review submitted evidence has severely hampered its ability to approve new technologies or services and has likewise left providers of new technologies or services without an avenue to secure Medicaid cover- age. As EBBRAC's website shows, it has not met since 2017.
This bill would amend the EBBRAC process to ensure that the DOH main- tains the ability to approve or disapprove new technologies or services without a vendor. It also provides a meaningful and transparent process for providers who seek to have such technology or service covered by Medicaid.
Legislative history
2021-2022: S6973 Rivera / A9289 Gottfried
2023-2024: S4787-A Rivera I A6022-A Paulin - Vetoed Memo. 31
Fiscal implications
None.
Effective date
This act shall take effect immediately.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.