BILL NUMBER: S4787A
SPONSOR: RIVERA
 
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 / A9289 Gottfried
 
FISCAL IMPLICATIONS:
None.
 
EFFECTIVE DATE:
This act shall take effect immediately.