Governor Hochul has signed A.463A/S.2677!
Next year plans will be required to include in an adverse determination letter: (1) instructions on how to initiate standard and expedited appeals; (2) notice of the availability, upon request of the enrollee, or the enrollee’s designee, of the clinical review criteria relied upon to make such determination; (3) what, if any, additional necessary information must be provided to, or obtained by, the utilization review agent in order to render a decision on the appeal; and (4) for an adverse determination related to a step therapy protocol override request, information that includes the clinical review criteria relied upon to make such determination and any applicable alternative prescription drugs subject to the step therapy protocol of the health care plan.
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Thank you to Governor Hochul, Senator Breslin and Assembly Member McDonald for your leadership and for supporting NY health care consumers! Aimed Alliance would also like to thank all the organizations that supported getting this legislation passed, it truly would not have been possible without your participation!
Last Updated on December 28, 2023 by Aimed Alliance
