New York State Executive Budget

No Memos in Support are available at this time.

To view the memo of opposition, simply click on the legislation interest.

A. 1708 (Gunther)/S.2148 (McDonald) "Autism Bill of Rights."
The Blue Cross and Blue Shield Plans of New York strongly oppose the enactment of this bill which attempts to provide a broad scheme of “rights” to persons with autism or autism spectrum disorders. This bill would directly conflict with several of the provisions included in the historic autism legislation passed during last year’s Legislative Session; a new law that has yet to even go into effect. In fact, this bill’s sponsor praised the enactment of last year’s new autism law and the protections it provides to those affected by autism spectrum disorders. But this proposed legislation would undo some of those protections; safeguards which were the subject of intense scrutiny, discussion, and careful consideration before being passed by both Houses of the Legislature and receiving the Governor’s signature. Undoing or compromising the carefully thought out protections present in that new law, especially considering that it has not even been implemented yet, would negate much of the passionate work done by legislators, the autism community, and insurance plans less than a year ago.
Updated 3/5/12

A.2820 (Morelle)/S.3059A (Libous)
The New York State Conference of Blue Cross and Blue Shield Plans strongly opposes the enactment of this legislation, which would permit certain oral and maxillofacial surgeons to perform an expanded scope of surgeries absent the training, experience, accountability, and demonstrated proficiency demanded of medical doctors. Specifically, this Bill would enable oral and maxillofacial surgeons (dental surgeons) to perform surgical procedures well beyond their current scope of practice – a practice rooted in the restoration and maintenance of dental health. This sweeping expansion of the practice of dentistry puts patients at risk of having surgery performed by non-physicians.
Updated 3/5/12

A.7431A (Morelle)/S.4597A (Hannon) "Office Based Surgery."
The New York State Conference of Blue Cross and Blue Shield Plans strongly opposes the enactment of this legislation, which would require the registration of office-based surgery facilities and would mandate the payment of an additional fee by health insurers for the utilization of these facilities. Specifically, this bill would require health insurers to pay the hospital facility fee for services provided at an office-based surgery center. Imposing this costly mandate upon health insurers would necessitate a commensurate increase in insurance premiums, making health insurance less affordable for individuals and businesses alike.
Updated 1/9/12

A.9293 (Pretlow)/S.3758A (Libous)
The Blue Cross and Blue Shield Plans of New York oppose enactment of this bill which would place the health of New Yorkers at risk by allowing inadequately trained individuals to provide health care treatment. This bill would expand the scope of practice of podiatrists beyond treatment of the foot. Specifically, it would allow podiatrists to diagnose, treat, operate and prescribe for any disease, injury or deformity of the foot and ankle and all soft tissue structures of the leg all the way up to the knee. The bill also allows for the treatment of systemic conditions that manifest in the lower leg.
Updated 3/5/12

S.5068A (Hannon) "Out of Plan Benefit Coverage."
The Blue Cross and Blue Shield Plans of New York strongly oppose the enactment of this legislation, which seeks to require that a health plans providing out-of-network benefits reimburse out of network providers “significant coverage” for the 80th percentile of the providers charges. The goal of the Bill is simply to pay nonparticipating providers a greater reimbursement which will be based on providers’ own charges. The result of the Bill will be a further increase in the cost of coverage.
Updated 1/9/12

New York State Division of Budget

Governor Cuomo’s Budget Presentation and Webcast

Agency Presentations

Briefing Book

No Memos in Support at this time

To view the memo of opposition, simply click on the legislation interest.

A. 594 (Gottfried) / No Same As. "In-Network Referrals."
This bill would prevent insurers from requiring that in-network providers refer only to other in-network providers. Specifically, this bill would prohibit insurers from restricting a health care provider from referring an insured to another provider based solely on the provider's participation status in the insured's health plan network. This bill has passed the Assembly.
Updated 2/17/11

A. 659 (Gottfried) / S.4509 (Hannon). "Utilization Review Standard."
This bill would impose an arbitrary utilization review standard, allow providers, at the expense of their patients, to appeal concurrent adverse determinations, deem medical necessity determinations outside the utilization review time period approved and create unnecessary preauthorization notification requirements given existing law. This bill has passed the Assembly. The Senate bill has been referred to the Senate Health Committee.
Updated 5/3/11

A.662 (Gottfried) / No Same As. "Definition of Clinical Peer Reviewer."
This bill would change the definition of “clinical per reviewer” to require a board certified specialist to render opinions of medical necessity for the initial review of the claim. The Legislation would require every claim that is submitted must be reviewed by a board certified specialist in the relevant specialty. This bill has passed the Assembly.
Updated 2/17/11

A. 809 (Gottfried) / S. 4664 (Maziarz)
This bill would severely limit insurers' flexibility in providing cost-effective prescription drug benefits by imposing onerous reporting, accounting and disclosure requirements on pharmacy benefit managers (PBMs). The bill imposes a fiduciary duty on PBMs, creates a trust for all funds received by PBMs, requires disclosure of financial transactions and mandates disclosure of terms and conditions for all contractual arrangements. Imposition of this bill’s onerous and unnecessary requirements would significantly increase administrative costs and diminish the value PBMs currently provide to New York’s employers and consumers. The bill has passed in the Assembly. The Senate bill is currently in the Health Committee.
Updated 6/9/11

A. 1808 (Dinowitz) / No Same As. "Disaffiliated Providers."
This bill would decrease the ability of managed care health plans to control quality and cost issues within their provider networks, and would significantly increase administrative costs associated with both provider and enrollee transitions. Existing law allows patients to continue receiving care from a non-participating provider for a period of 60 or 90 days depending on circumstances. This bill would significantly expand these time periods by allowing patients to receive care for up to a year or an indefinite period of time if the individual was diagnosed with a terminal condition. The bill has passed in the Assembly.
Updated 2/17/11

A.1937 (Hoyt) / S.1803 (LaValle)
This bill would establish criteria for the licensure of naturopaths and create the profession of Naturopathic Medicine. This bill would place the health of New Yorkers at risk by allowing inadequately trained individuals to provide health care treatment without physician oversight. The bill will also increase health insurance costs because it creates a new scope of practice requiring insurance coverage. The Assembly bill has been referred to the Higher Education Committee. The Senate bill has passed.
Updated: 6/30/11

A. 2474 (Canestrari) / S.3186 (Hannon). "Collective Negotiations."
This bill provides for “collective negotiation” by physicians and other health care providers. Although this legislation purports to create new authority to permit physicians to collectively negotiate with payers, it is actually a transparent attempt to exempt physicians from the state’s anti-trust laws and unfairly empowers physicians in negotiation with health plans. The Assembly bill was referred to the Assembly Ways and Means Committee from the Assembly Health Committee. The Senate bill has passed.
Updated 6/30/11

A.4093 (Morelle) / S.2714 (Seward). Payments to prehospital EMS providers.
This bill would require insurers to directly reimburse all ambulance providers, thereby eliminating the incentive to be “in-network.” The bill also requires the reimbursement to be at the “provider’s usual and customary charge.” This standard is inconsistent with other sections of the insurance law and allows providers to unilaterally dictate charges. The bill would also create a significant administrative burden for plans and has the potential to impose prompt pay penalty liability even with a good faith effort by the plan to provide proper and timely reimbursement. The Assembly and Senate bill are both currently in their respective insurance committee’s. The Assembly bill has been reported to the floor from the Rules Committee. The Senate bill is currently on floor.
Updated 6/30/11

A. 5502 (Heastie) / S. 3510 (Maziarz)
This bill would severely limit insurers' flexibility in providing cost-effective prescription drug benefits. The bill would prohibit policies covering prescription drugs from requiring that the drugs be purchased through a mail-order pharmacy. Restrictions on mail-service pharmacies unfairly limit the ability of employers to design cost-effective prescription drug benefits and ultimately harm consumers by raising the costs of prescriptions and restrict consumer choice. The Assembly bill has passed. The Senate bill has passed.
Updated 6/30/11

A. 6305 (Morelle) / S. 4005 (Fuschillo)
This bill would impose a costly and complex mandate on New Yorkers with health insurance coverage. The bill requires coverage for a broad array of autism-related treatments, many of which are completely unrelated to healthcare services. The bill is far more costly, ambiguous and broader in scope than virtually every other autism mandate enacted in any other state in the country. The Assembly bill has passed. The Senate bill has passed.
Updated 6/30/11

A. 6039 (Kellner) / S. 3865 (Robach)
This bill would require reimbursement for outpatient blood clotting factor treatments under the Child Health Plus, Family Health Plus and Healthy New York programs. The bill would require reimbursement for outpatient use of the exceedingly expensive treatments associated with hemophilia and other similar blood clotting disorders. The benefit is currently covered in an inpatient setting and therefore an effective and affordable option is available. However, because the treatments and services for blood clotting deficiencies are extraordinarily expensive, if there’s a mandate reimbursement requirement for the above programs, the associated health insurance premium increases would need to follow suit. The Assembly bill has been referred to the Assembly Ways & Means Committee from the Health Committee. The Senate bill has been referred to the Senate Finance Committee from the Senate Health Committee.
Updated 6/30/11

A. 7431 (Morelle) / S. 4597 (Hannon)
This bill would require the registration of office-based surgery facilities and would mandate the payment of an additional fee by health insurers for the utilization of these facilities. Specifically, this bill would require health insurers to pay the hospital facility fee for services provided at an office-based surgery center. Imposing this costly mandate upon health insurers would necessitate a commensurate increase in insurance premiums, making health insurance less affordable for individuals and businesses alike. The bill would also disrupt market based principles of provider reimbursement by mandating a certain level of reimbursement for a specific provider, which will have a reverberating effect on other provider reimbursement. The Assembly bill has been referred to the Health Committee. The Senate bill has passed.
Updated 6/30/11

View the New York State Conference of Blue Cross and Blue Shield Plans' Statement on the 2010-2011 Executive Budget

View a transcript of remarks and written testimony from David Klein, President and CEO of Excellus BlueCross BlueShield, before the Joint Legislative Budget Hearing on Heath/Medicaid
Posted 2/10/10

The following prior approval video was aired in Spring 2010

Freedom Health Insurance Policies - A.2524
This bill creates freedom policies, an affordable alternative to existing health insurance plans, and provides additional tax credits to small business owners.

Medical Liability Insurance Reform - A.3139/S.2144
This bill provides beneficial reforms to address these problems including: a $250,000 cap on non-economic damages; a requirement that certificates of merit in malpractice cases include a physician's affidavit attesting to the merits of the case and a requirement that the identity of an expert witness be disclosed prior to trial.

To view the memo of opposition, simply click on the legislation interest.

A.10372 (Morelle) / S.7000-B (Breslin) “Autism Spectrum Disorder Mandate”
This bill imposes an ambiguous and complex mandate on private health insurance plans without any analysis or input from the legislatively-created “Mandate Review Commission. ” Such an effort is counterintuitive at a time when policymakers are struggling to find ways to keep health insurance affordable and the federal regulatory landscape is changing dramatically. The bill passed in the Senate and Assembly and has recently been vetoed by the governor (veto memo 6832).
Updated 10/15/10

A.10136 (Gunther) / S.6894 (Johnson) “The HALO Breast Pap Test”
This bill would require insurance coverage for the brand name device – HALO breast pap test – to detect risk of developing breast cancer. This Senate bill is currently on the Floor Calendar. The Assembly bill is currently been held for consideration.
Updated 10/15/10

A.9896 (Morelle)/ S.3180-A (Duane) "Out of Network Clinical Laboratories."
This bill would require managed care plans, to reimburse out-of-network providers of clinical laboratory services when plan participants are referred to such laboratories for services by an in-network provider. The Senate bill is currently in the Insurance Committee. The Assembly bill is currently in the Insurance Committee. The Senate bill has been ordered to the floor from the Rules committee.
Updated 10/15/10

A.9717 (Gottfried) / S.6616 (Montgomery) “School-based Health Centers”
This bill would allow direct access to school-based health centers under child health plus – effectively removing the ability of a child’s primary care provider to provide care coordination. The bill has passed in the Assembly and Senate, but has been vetoed by the governor (veto 6804).
Updated 10/15/10

A.8278A (Kellner) / S.5000-A (Duane) “Creation of Specialty Tiers within Prescription Drug Formularies”
This bill seeks to prohibit commercial health insurance plans from creating specialty tiers within their prescription drug formularies, a practice which is already prohibited by the Insurance Department. The overly broad language contained in the bill, however, could have the effect of limiting future innovative, cost-saving products. The bill has passed in the Assembly and Senate and signed by the governor (chap. 536).
Updated 10/15/10

A.7355 (Lopez) / S.5864 (Hassell-Thompson) "Orally Administered Chemotherapy"
This bill would require health insurance plans in New York to cover orally administered chemotherapy treatment no less favorably than intravenously administered or injected chemotherapy treatments. The bill is currently in both the respective Assembly and Senate Insurance committee's.
Updated 10/15/10

A.5659 (Rivera P.) / S.1646 (Huntley) "Timothy's Law Extension."
This bill would make Timothy’s Law permanent and impose duplicative reporting requirements on the Office of Mental Health. The Assembly bill enacting clause has been stricken. The Assembly bill is currently in the insurance committee.
Updated 10/15/10

A.5448 (Perry) / S.2836 (Klein) “Prohibits Prescription Drug Incentives”
This bill would prohibit insurers from including in their contracts with health care providers any cost saving mechanisms or incentives involving medical products or prescription drugs. The bill has passed the Assembly. The Senate bill is in the Health Committee.
Updated 10/15/10

A. 5243 (Morelle) / S. 529 (Alesi) "Hearing Aid Coverage."
This bill would entitle hearing impaired consumers, 16 years of age or older, to receive reimbursement of $1,000 every three years for the costs associated with the purchase of up to two hearing aids. Hearing impaired children, 15 and younger, would be entitled to reimbursement of $1,000 for services related to the purchase of up to two hearing aids every two years. The bill is in their respective Assembly & Senate insurance committee's.
Updated 10/15/10

A. 4572 (Rivera) / S. 185 (Morahan) "PTSD Expansion of Timothy's Law."
This bill would: 1) add “Post Traumatic Stress Disorder” (PTSD) to the list of biologically based mental illnesses that insurers and health maintenance organizations are required to cover under “Timothy’s Law”; and, 2) authorize the Commissioner of Mental Health to participate in the ongoing study the impact of Timothy’s law. The Assembly bill is currently in the insurance committee. The Senate bill was referred to the Senate floor calendar from the Senate Finance Committee.
Updated 10/15/10

A. 4301 (Canestrari) / S.5204 "Collective Negotiations."
This bill provides for “collective negotiation” by physicians and other health care providers. Although this legislation maintains it will create new authority to permit physicians to collectively negotiate with payers, it is actually a transparent attempt to exempt physicians from the state’s anti-trust laws and unfairly empowers physicians in negotiation with health plans. The Assembly bill was referred to the Assembly Ways and Means Committee from the Assembly Health Committee. The Senate bill has been ordered to the floor from the health committee.
Updated 10/15/10

A. 2368 (O'Donnell) / S.960 (Johnson C.) "Domestic Partner Coverage."
This would set forth an unclear and overly broad mandate for health insurance coverage for domestic partners. Specifically, this bill would alter the definition of family in the insurance law to include domestic partners thus requiring insurers to provide health insurance to an insured's domestic partner. The Assembly bill has passed and the Senate bill is currently in the Senate Insurance Committee.
Updated 10/15/10

A. 2008 (Gottfried) / S.3930 (Duane) "PBM Regulation."
This bill would severely limit insurers' flexibility in providing cost-effective prescription drug benefits by imposing onerous reporting, accounting and disclosure requirements on pharmacy benefit manager (PBMs). Specifically, the bill imposes a fiduciary duty on PBMs, creates a trust for all funds received by a PBM, requires disclosure of financial transactions and mandates disclosure of terms and conditions of all contractual arrangements. This bill has passed the Assembly. The Senate bill is currently in the Health Committee.
Updated 10/15/10

A. 1370 (Hoyt) / S. 1930 (Lavalle) "Naturopathy Certification."
This bill would establish criteria for the certification of naturopathic medicine and would create the profession of Naturopathic Medicine professionals. In addition, this measure would license naturopaths and allow them to prescribe, administer, dispense and perform natural therapies, to prescribe and administer drugs, immunizing agents, diagnostic tests and devices, and to order laboratory tests. Subsequently, this bill would place the health of New Yorkers at risk by allowing inadequately trained individuals to provide health care treatment. The Assembly bill is currently been held for consideration in the higher education committee. The Senate bill is currently in the higher education committee.
Updated 10/15/10

A. 1267 (Colton) / S.6007 (Breslin) "Mail Order Pharmacy Restrictions."
This bill severely limits insurers' flexibility in providing cost effective prescription drug benefits. This bill would prohibit policies covering prescription drugs from requiring that the drugs be purchased through a mail-order pharmacy. Restrictions on mail-service pharmacies unfairly limit the ability of insurers and employers to design cost-effective prescription drug benefits and ultimately harms consumers by raising the cost of prescription coverage. Both the Assembly and Senate bills are in their respective insurance committee's.
Updated 10/15/10

A. 792 (Gottfried) / No Same As "Utilization Review Standard."
This bill would impose an arbitrary utilization review standard, allow providers, at the expense of their patients, to appeal concurrent adverse determinations, deem medical necessity determinations outside the utilization review time period approved and create unnecessary preauthorization notification requirements given existing law. This bill has passed the Assembly.

A. 770 (Gunther) / S.2893 (Bonacic) "Prosthetic Devices."
This bill would require health plans to cover prosthetic devices in a manner that is equal to or greater than the coverage provided by Medicare. Due to the broad definition given to prosthetics by Medicare, the bill is overreaching and will have unintended consequences. The bill has been held in the Assembly Insurance Committee. The Senate bill is currently in the insurance committee. Updated 10/15/10

A. 767 (Gottfried) / No Same As "Health Plan Liability."
This bill imposes unfair liability standards on health insurers and managed care health plans making routine coverage determinations. Enactment of this bill would actually diminish the accessibility of health care services and the affordability of health care coverage. The Assembly bill is currently in the judiciary committee.
Updated 10/15/10

A.764 (Gottfried) / S.3905 "Newly Licensed Providers."
This bill would require managed care plans to allow newly licensed health care professionals to become participating providers and provide services and receive payment from the network while their applications are pending. This bill has passed the Assembly. The Senate bill is currently in the Health Committee.
Updated 10/15/10

A. 729 (Gottfried) / S.3909 "Grounds for External Appeal."
This bill would establish unclear and unjustified standards for medical necessity external appeals and give undue weight to the recommendations of providers that lack appropriate qualifications. Specifically, this bill would result in the existence of two competing standards to be used in determining medical necessity external appeals without providing any guidance for when each standard should be applied. This bill has passed the Assembly. This bill has passed the Assembly. The Senate bill is currently in the Health Committee.
Updated 10/15/10

A. 728 (Gottfried) / No Same As "Third-Party Notification of External Appeals."
This bill would eliminate the $50 application fee an insured must pay in order to file an external appeal. In addition, the bill requires that notification be provided to the patient's designee and the healthcare provider of a utilization review final adverse determination and an external appeal determination. This bill has passed the Assembly.

A. 726 (Gottfried) / S.4112 (Klein) "In-Network Referrals."
This bill would prevent insurers from requiring that in-network providers refer only to other in-network providers. Specifically, this bill would prohibit insurers from restricting a health care provider from referring an insured to another provider based solely on the provider's participation status in the insured's health plan network. This bill has passed the Assembly. The Senate bill is currently in the Health Committee.

A.723 (Gottfried) / S. 3450 (Oppenheimer) "Definition of Clinical Peer Reviewer."
This bill would require the initial determination of medical necessity on a claim to be made by a board certified specialist in the same or similar specialty as the physician who recommended the treatment under review. This bill has passed the Assembly and has been referred to the Senate Floor Calendar.

A. 693 (Jacobs) / No Same As "Smoking Cessation Mandate."
This bill would require insurers to provide coverage for the cost of smoking cessation programs for their enrollees. Specifically, insurance plans would be mandated to provide four hundred dollars worth of coverage on an annual basis towards the cost of a prescription smoking cessation program. The bill is currently in the Assembly Insurance Committee.
Updated 10/15/10

A. 376 (Jacobs) / No Same As "Audiological Exams."
This bill would require insurers to provide coverage for annual audiological examinations and evaluations performed by a licensed physician or licensed audiologist. This bill would also require coverage for an unlimited number of speech language pathology examinations and evaluations that are recommended by a licensed physician, licensed audiologist or licensed speech language pathologist, upon completion of the annual examination. A. 633 (Dinowitz) "Disaffiliated Providers." This bill would decrease the ability of managed care health plans to control quality and cost issues within their provider networks, and would significantly increase administrative costs associated with both provider and enrollee transitions. Existing law allows patients to continue receiving care from a non-participating provider for a period of 60 or 90 days depending on circumstances. This bill would significantly expand these time periods by allowing patients to receive care for up to a year or an indefinite period of time if the individual was diagnosed with a terminal condition. The bill is currently in the Assembly Insurance Committee.
Updated 10/15/10

A. 301 (Millman) / S.3840 (Duane) "Review of Rare Diseases."
This bill seeks to unnecessarily and unjustifiably relax the existing standard used in medical necessity determinations for not only external appeals but internal utilization review decisions for a specified and expanding set of rare diseases which are listed by the National Institutes of Health Office of Rare Diseases. The Assembly bill enacting clause has been stricken. The Senate bill is currently in the Health Committee.
Updated 10/15/10

A. 217 (Latimer) / S.5456 (Duane) "Third-Party Notification of Termination."<
This bill would require insurers and HMOs to allow individuals over 65 years old to designate a 3rd party to receive notices of failure to pay premiums or cancellation due to the failure to pay premiums. In addition, insurers would be required to annually provide notice to eligible insureds of this option. This bill has passed the Assembly & Senate and has been signed by the governor (Chap. 49).
Updated 10/15/10

A. 214 (Jeffries) / No Same As "Insurance Reimbursement of Wages for Organ Donors."
This Bill would require insurers to reimburse private employers for wages paid to an employee while such employee is on a leave of absence to serve as an organ or bone marrow donor. The bill is currently in the Assembly Labor Committee.
Updated 10/15/10

A. 213 (Markey) / S.1803 (Breslin) "Temporary Out-of-Network Dialysis Treatments."
This bill would require insurers to provide coverage for out-of-network dialysis. Specifically, this bill would prohibit insurers from denying coverage to an insured who receives dialysis from an out-of-network provider where the healthcare provider treating the insured issues a written order for dialysis treatment and the insured notifies the insurer of the date or dates of such treatment 30 days in advance. This bill would limit out-of-network dialysis coverage to 4 four requests not to exceed 15 treatments a year. In addition, the bill limits reimbursement to the amount the insurer would have paid for the same treatment performed in- network. Any excess amount charged by the provider would be the responsibility of the insured. The bill has passed in the Assembly and the Senate, and signed by the governor (Chap. 457).
Updated 10/15/10

A.211 (Schimel) / S.713 (Johnson C.) “Insurance Coverage for Wheelchairs”
This bill would regulate the timing of insurance approvals for wheelchairs and create an unnecessary and aggressive timeframe for a utilization review decision. The bill also implies that the insurer pay claims directly to the wheelchair manufacturer even though there is no contractual relationship and could in fact be a violation of the subscriber’s contract. The bill has passed in the Senate. The Assembly bill is currently in the insurance committee.
Updated 10/15/10

S. 5507 (Klein) / No Same As "Participating Provider Web-Lists."
This bill seeks to penalize health plans that voluntarily offer a list of participating providers via the plan’s website for failure to remove providers who no longer participate with the plan within thirty (30) days. In addition, this bill would require that services rendered by non-participating providers whose names appear on the website be reimbursed for services at out-of-network (OON) rates. The bill is currenlty in the Senate Insurance Committee.
Updated 10/15/10

S. 650 (Larkin) / No Same As "Small Business Insurance Cooperatives."
This bill would establish private health care purchasing cooperatives to expand health care choices for sole proprietors and small employers in New York. Bill is currently in the Senate Insurance Committee.
Updated 10/15/10

S. 417 (Breslin) / No Same As "Health Plan Responsibility."
This bill would impose unfair responsibility standards on health insurers and managed care health plans making routine coverage determinations. Perversely, enactment of this bill would actually diminish the accessibility of health care services and the affordability of health care coverage. The bill is in the Senate Judiciary Committee.
Updated 10/15/10