New York S 7297: Relates to declaring a climate emergency

Bill Text

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S07297 Summary:

BILL NOS07297A

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SAME ASSAME AS A03789-A

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SPONSORHOYLMAN-SIGAL

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COSPNSRADDABBO, BASKIN, CLEARE, COMRIE, FERNANDEZ, GALLIVAN, GONZALEZ, JACKSON, KRUEGER, LIU, MAY, RHOADS,
 RIVERA, WALCZYK, WEBB

&nbsp

MLTSPNSR

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Amd §§4902 & 4903, Pub Health L; amd §§4902 & 4903, Ins L

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Relates to utilization review program standards; requires use of evidence-based and peer reviewed clinical review criteria; relates to prescription drug formulary changes and pre-authorization for certain health care services.

Go to top S07297 Actions:

BILL NOS07297A

&nbsp

04/09/2025REFERRED TO HEALTH

05/28/20251ST REPORT CAL.1390

05/29/20252ND REPORT CAL.

06/04/2025ADVANCED TO THIRD READING 

06/09/2025AMENDED ON THIRD READING 7297A

06/13/2025COMMITTED TO RULES

Go to topS07297 Committee&nbspVotes:

Go to topS07297 Floor&nbspVotes:

There are no Assembly votes for this bill in this legislative session.

Go to topS07297 Text:

 STATE OF NEW YORK
 ________________________________________________________________________

 7297--A
 Cal. No. 1390

 2025-2026 Regular Sessions

 IN SENATE

 April 9, 2025
 ___________

 Introduced by Sens. HOYLMAN-SIGAL, ADDABBO, CLEARE, COMRIE, FERNANDEZ,
 GALLIVAN, GONZALEZ, JACKSON, KRUEGER, LIU, MAY, RIVERA, WALCZYK, WEBB
 -- read twice and ordered printed, and when printed to be committed to
 the Committee on Health -- reported favorably from said committee,
 ordered to first and second report, ordered to a third reading,
 amended and ordered reprinted, retaining its place in the order of
 third reading

 AN ACT to amend the public health law and the insurance law, in relation
 to utilization review program standards and pre-authorization of
 health care services

 The People of the State of New York, represented in Senate and Assem-
 bly, do enact as follows:

 1 Section 1. Paragraph (c) of subdivision 1 of section 4902 of the
 2 public health law, as added by chapter 705 of the laws of 1996, is
 3 amended to read as follows:
 4 (c) Utilization of written clinical review criteria developed pursuant
 5 to a utilization review plan. Such clinical review criteria shall
 6 utilize recognized evidence-based and peer reviewed clinical review
 7 criteria that take into account the needs of a typical patient popu-
 8 lations and diagnoses;
 9 § 2. Paragraph (a) of subdivision 2 of section 4903 of the public
 10 health law, as separately amended by section 13 of part YY and section 3
 11 of part KKK of chapter 56 of the laws of 2020, is amended to read as
 12 follows:
 13 (a) A utilization review agent shall make a utilization review deter-
 14 mination involving health care services which require pre-authorization
 15 and provide notice of a determination to the enrollee or enrollee's
 16 designee and the enrollee's health care provider by telephone and in
 17 writing within [three business days] seventy-two hours of receipt of the
 18 necessary information, or for inpatient rehabilitation services follow-
 19 ing an inpatient hospital admission provided by a hospital or skilled

 EXPLANATION--Matter in italics (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD07503-03-5

 S. 7297--A 2

 1 nursing facility, within one business day of receipt of the necessary
 2 information. The notification shall identify[;]: (i) whether the
 3 services are considered in-network or out-of-network; (ii) and whether
 4 the enrollee will be held harmless for the services and not be responsi-
 5 ble for any payment, other than any applicable co-payment or co-insu-
 6 rance; (iii) as applicable, the dollar amount the health care plan will
 7 pay if the service is out-of-network; and (iv) as applicable, informa-
 8 tion explaining how an enrollee may determine the anticipated out-of-
 9 pocket cost for out-of-network health care services in a geographical
 10 area or zip code based upon the difference between what the health care
 11 plan will reimburse for out-of-network health care services and the
 12 usual and customary cost for out-of-network health care services. An
 13 approval for a request for pre-authorization shall be valid for (1) the
 14 duration of the prescription, including any authorized refills and (2)
 15 the duration of treatment for a