N.Y. Social Services Law Section 365-D
Medicaid evidence based benefit review advisory committee


1.

The department shall convene a Medicaid evidence based benefit review advisory committee. The committee shall provide advice and make recommendations regarding coverage of health technology or service for purposes of the medical assistance program. The commissioner shall consult such committee prior to any determination made regarding the coverage status of a particular item, health technology or service based on procedures established in subdivision five of this section under the medical assistance program. For purposes of this section, “health technology” means medical devices and surgical procedures used in the prevention, diagnosis and treatment of disease and other medical conditions. For purposes of this section “services” means any medical or behavioral health procedure.

2.

(a) The membership of such committee shall, at a minimum, include:

(i)

at least three persons licensed and actively engaged in the practice of medicine in this state;

(ii)

one person licensed and actively engaged in the practice of nursing as a nurse practitioner, or in the practice of midwifery in this state;

(iii)

one person with expertise in health technology assessment or evidence based medical review who is preferably a health care professional licensed under title eight of the education law;

(iv)

three persons who shall be consumers or representatives of organizations with a regional or statewide constituency and who have been involved in activities related to health care consumer advocacy;

(v)

one person who is a representative of a hospital organization with a regional, national or statewide constituency;

(vi)

one person who is a representative of a health insurance or managed care organization with a regional, statewide or national constituency;

(vii)

one person who is a health economist;

(viii)

one person with health care expertise who is appointed by the temporary president of the senate;

(ix)

one person with health care expertise who is appointed by the speaker of the assembly;

(x)

a member of the department who shall act as chairperson as designated by the commissioner; and

(xi)

the committee may invite and consult with scientific, technical, or clinical experts with demonstrable experience or knowledge of the technology or medical specialty area under review.

3.

The department shall provide video or audio access to all meetings of such committee through the department’s website.

4.

The members of the committee shall receive no compensation for their services but shall be reimbursed for expenses actually and necessarily incurred in the performance of their duties unless expressly stated otherwise in this section, members shall be appointed by the commissioner. Members shall serve three year terms, and may be reappointed for subsequent terms. Committee members shall be deemed to be employees of the department for purposes of Public Officers Law § 17 (Defense and indemnification of state officers and employees)section seventeen of the public officers law, and shall not participate in any matter before the committee for which a conflict of interest exists.

5.

The committee shall consider any matter regarding material changes in the coverage status of a particular item, health technology or service, and any matter relative to new health technology assessment or medical evidence review for which the department determines a sufficient body of evidence exists to warrant committee deliberation. The commissioner shall provide members of the committee with any evidence or information related to the health technology or medical service assessment including but not limited to, information submitted by members of the public. The department shall report to the committee programmatic changes to benefits that do not rise to the level of a material change, as well as determinations of when sufficient medical evidence exists to warrant committee deliberations. The commissioner shall provide forty-five days public notice on the department’s website prior to any meeting of the committee to develop recommendations concerning health technology or medical service coverage determinations. Such notice shall include a description of the proposed health technology or service to be reviewed, the conditions or diseases impacted by the health technology or service, the proposals to be considered by the committee, and the systematic evidence-based assessment prepared in accordance with this subdivision. The committee shall allow interested parties a reasonable opportunity to make an oral presentation to the committee related to the health technology or service to be reviewed and to submit written information. The committee shall consider any information provided by any interested party, including, but not limited to, health care providers, health care facilities, patients, consumers and manufacturers. For all health technologies or services selected for review, the department shall conduct or commission a systematic evidence-based assessment of the health technology’s or service’s safety and clinical efficacy. The assessment shall use established systematic review elements, study quality assessment, and data synthesis. Upon completion, the systematic, evidence-based assessment shall be made available to the public.

6.

The commissioner shall provide notice of any coverage recommendations developed by the committee by making such information available on the department’s website. Such public notice shall include: a summary of the deliberations of the committee; a summary of the positions of those making public comments at meetings of the committee and any safety and health outcomes data submitted by any interested party; the response of the committee to those comments, if any; the clinical evidence upon which the committee bases its recommendations; and the findings and recommendations of the committee including a final evidence-based systematic assessment.

7.

The commissioner shall provide public notice on the department’s website of the committee’s recommendation and the department’s final determination, including: the nature of the determination; an analysis of the impact of the department’s determination on the state Medicaid plan populations and providers; and the projected fiscal impact to the state Medicaid program.

8.

The recommendations of the committee, made pursuant to this section, shall be based on a review of the evidence presented to the committee, including the clinical effectiveness, patient outcomes, impact on at risk and underserved populations, and safety. The committee shall review previous recommendations of the committee as new evidence becomes available and permit oral presentations and the submission of new evidence at any committee meeting. Such review shall occur pursuant to the procedure established in subdivisions five and six of this section. The department may alter or revoke the final determination after such review pursuant to the procedure established in subdivision seven of this section.

9.

The department shall provide administrative support to the committee.

Source: Section 365-D — Medicaid evidence based benefit review advisory committee, https://www.­nysenate.­gov/legislation/laws/SOS/365-D (updated May 1, 2015; accessed Oct. 26, 2024).

363
Declaration of objects
363‑A
Federal aid
363‑B
Agreements for federal determination of eligibility of aged, blind and disabled persons for medical assistance
363‑C
Medicaid management
363‑D
Provider compliance program
363‑E
Medicaid plan, applications for waivers and plan amendments
363‑F
Electronic visit verification for personal care and home health providers
364
Responsibility for standards
364‑A
Cooperation of state departments
364‑B
Residential and medical care placement demonstration projects
364‑C
National long term care channeling demonstration project
364‑D
Medical assistance research and demonstration projects
364‑E
Aid to families with dependent children homemaker/home health aide demonstration projects
364‑F
Primary care case management programs
364‑G
Medical assistance capitation rate demonstration project
364‑H
Foster family care demonstration programs for elderly or disabled persons
364‑I
Medical assistance presumptive eligibility program
364‑J
Managed care programs
364‑J‑2
Transitional supplemental payments
364‑JJ
Special advisory review panel on Medicaid managed care
364‑KK
Condition of Participation
364‑M
Statewide patient centered medical home program
364‑N
Diabetes and chronic disease self-management pilot program
365
Responsibility for assistance
365‑A
Character and adequacy of assistance
365‑B
Local medical plans: professional directors
365‑C
Medical advisory committee
365‑D
Medicaid evidence based benefit review advisory committee
365‑E
Optional or continued membership in entities offering comprehensive health services plans
365‑F
Consumer directed personal assistance program
365‑G
Utilization review for certain care, services and supplies
365‑H
Provision and reimbursement of transportation costs
365‑J
Advisory opinions
365‑K
Provision of prenatal care services
365‑L
Health homes
365‑M
Administration and management of behavioral health services
365‑N
Department of health assumption of program administration
365‑O
Provision and coverage of services for living organ donors
365‑P
Doulas for Medicaid
366
Eligibility
366‑A
Applications for assistance
366‑B
Penalties for fraudulent practices
366‑C
Treatment of income and resources of institutionalized persons
366‑D
Medical assistance provider
366‑E
Certified home health agency medicare billing
366‑F
Persons acting in concert with a medical assistance provider
366‑G
Newborn enrollment for medical assistance
366‑H
Automated system
366‑I
Long-term care financing demonstration program
367
Authorization for hospital care
367‑A
Payments
367‑B
Medical assistance information and payment system
367‑C
Payment for long term home health care programs
367‑D
Personal care need determination
367‑E
Payment for AIDS home care programs
367‑F
Partnership for long term care program
367‑G
Authorization and provision of personal emergency response services
367‑H
Payment for assisted living programs
367‑I
Personal care services provider assessments
367‑O
Health insurance demonstration programs
367‑P
Responsibilities of local districts for personal care services, home care services and private duty nursing
367‑P*2
Payment for limited home care services agencies
367‑Q
Personal care services worker recruitment and retention program
367‑R
Private duty nursing services worker recruitment and retention program
367‑S
Long term care demonstration program
367‑S*2
Emergency medical transportation services
367‑T
Payment for emergency physician services
367‑U
Payment for home telehealth services
367‑V
County long-term care financing demonstration program
367‑W
Health care and mental hygiene worker bonuses
367‑X
Payment for violence prevention programs
367‑Y
Reimbursement for treatment in place and transportation to alternative health care settings
368
Quarterly estimates
368‑A
State reimbursement
368‑B
State reimbursement to local health districts
368‑C
Audit of state rates of payment to providers of health care services
368‑D
Reimbursement to public school districts and state operated/state supported schools which operate pursuant to article eighty-five, eighty...
368‑E
Reimbursement to counties for pre-school children with handicapping conditions
368‑F
Reimbursement of costs under the early intervention program
369
Application of other provisions

Accessed:
Oct. 26, 2024

Last modified:
May 1, 2015

§ 365-D’s source at nysenate​.gov

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