BILL NUMBER: S2800
SPONSOR: BRESLIN
 
TITLE OF BILL:
An act to amend the insurance law and the public health law, in relation
to enhanced disclosure of step therapy override requests and determi-
nations; and to repeal certain provisions of such laws relating thereto
 
PURPOSE OR GENERAL IDEA OF BILL:
The purpose of this bill is to require insurers and utilization review
agents to report to the Department of Financial Services (DFS) and
require insurers and certain health organizations to make publicly
available certain information on step therapy override requests,
appeals, and their outcomes.
 
SUMMARY OF PROVISIONS:
Section one amends section 4903 of the insurance law to require each
health care plan and utilization review agents to annually report infor-
mation to DFS regarding step therapy override requests and determi-
nations. The report must include, but is not limited to, the number of
step therapy override determination requests. In addition, the report
must include the type of health care providers submitting requests The
report must include the number of step therapy override determination
requests that were initially denied and the reasons for such denials.
The report must include the number of step therapy override determi-
nation requests that were initially approved and the number of requests
that were reversed upon appeal.
The utilization review agent is also required to disclose the same non-
confidential information, listed above, in a form the Superintendent
requires and must post on a readily accessible website.
Section two amends section 4903 of the public health law with the same
requirements as section one.
Section three repeals section 3217-a of the insurance law and adds three
new subsections. New subsection (g) requires each insurer subject to
this article to disclose information on step therapy protocols, step
therapy override determinations, internal and external appeals, and
associated clinical review information on a publicly accessible website
and upon request in written or electronic form. Subsection (h) requires
such insurers to update their websited with information related to any
new requirement or restrictions before implementation. Finally,
subsection (1) requires such insurers to provide any insured or health
care professional who may be impacted by any new requirements,
restrictions, or amendments with written notice no less than 60 days
before implementation.
Section four repeals subsection (b) of section 4324 of the insurance law
and adds three new subsections similar to the amendments from section
three. These disclosure requirements apply to each health service,
hospital service, or medical indemnity corporation subject to this arti-
cle.
Section five repeals subdivision two of section 4408 of the public
health law and adds three new subdivisions similar to the amendments
made in sections three and four of this bill. These disclosure require-
ments apply to each health maintenance organization subject to this
article.
Section six requires that this act shall take effect immediately.
 
JUSTIFICATION:
Reporting requirements are essential to understand whether insurers are
complying with the law. It also allows patients and providers equal
access to information. Publication of step therapy data also provides
the patients, health care professionals, and policymakers the opportu-
nity to identify potential violations of the law and room for improve-
ment.
 
PRIOR LEGISLATIVE HISTORY:
S8798 - 2021/22
 
FISCAL IMPLICATIONS:
None
 
EFFECTIVE DATE:
This act shall take effect immediately.

Statutes affected:
S2800: 4903 insurance law, 4903 public health law, 3217-a insurance law, 3217-a(b) insurance law, 4324 insurance law, 4324(b) insurance law