§ 365-D — Medicaid evidence based benefit review advisory committee

§ 365-d. Medicaid evidence based benefit review advisory committee. 1.\nThe department shall convene a Medicaid evidence based benefit review\nadvisory committee. The committee shall provide advice and make\nrecommendations regarding coverage of health technology or service for\npurposes of the medical assistance program. The commissioner shall\nconsult such committee prior to any determination made regarding the\ncoverage status of a particular item, health technology or service based\non procedures established in subdivision five of this section under the\nmedical assistance program. For purposes of this section, "health\ntechnology" means medical devices and surgical procedures used in the\nprevention, diagnosis and treatment of disease and other medical\nconditions. For purposes of this section "services" means any medical or\nbehavioral health procedure.\n 2. (a) The membership of such committee shall, at a minimum, include:\n (i) at least three persons licensed and actively engaged in the\npractice of medicine in this state;\n (ii) one person licensed and actively engaged in the practice of\nnursing as a nurse practitioner, or in the practice of midwifery in this\nstate;\n (iii) one person with expertise in health technology assessment or\nevidence based medical review who is preferably a health care\nprofessional licensed under title eight of the education law;\n (iv) three persons who shall be consumers or representatives of\norganizations with a regional or statewide constituency and who have\nbeen involved in activities related to health care consumer advocacy;\n (v) one person who is a representative of a hospital organization with\na regional, national or statewide constituency;\n (vi) one person who is a representative of a health insurance or\nmanaged care organization with a regional, statewide or national\nconstituency;\n (vii) one person who is a health economist;\n (viii) one person with health care expertise who is appointed by the\ntemporary president of the senate;\n (ix) one person with health care expertise who is appointed by the\nspeaker of the assembly;\n (x) a member of the department who shall act as chairperson as\ndesignated by the commissioner; and\n (xi) the committee may invite and consult with scientific, technical,\nor clinical experts with demonstrable experience or knowledge of the\ntechnology or medical specialty area under review.\n 3. The department shall provide video or audio access to all meetings\nof such committee through the department's website.\n 4. The members of the committee shall receive no compensation for\ntheir services but shall be reimbursed for expenses actually and\nnecessarily incurred in the performance of their duties unless expressly\nstated otherwise in this section, members shall be appointed by the\ncommissioner. Members shall serve three year terms, and may be\nreappointed for subsequent terms. Committee members shall be deemed to\nbe employees of the department for purposes of section seventeen of the\npublic officers law, and shall not participate in any matter before the\ncommittee for which a conflict of interest exists.\n 5. The committee shall consider any matter regarding material changes\nin the coverage status of a particular item, health technology or\nservice, and any matter relative to new health technology assessment or\nmedical evidence review for which the department determines a sufficient\nbody of evidence exists to warrant committee deliberation. The\ncommissioner shall provide members of the committee with any evidence or\ninformation related to the health technology or medical service\nassessment including but not limited to, information submitted by\nmembers of the public. The department shall report to the committee\nprogrammatic changes to benefits that do not rise to the level of a\nmaterial change, as well as determinations of when sufficient medical\nevidence exists to warrant committee deliberations. The commissioner\nshall provide forty-five days public notice on the department's website\nprior to any meeting of the committee to develop recommendations\nconcerning health technology or medical service coverage determinations.\nSuch notice shall include a description of the proposed health\ntechnology or service to be reviewed, the conditions or diseases\nimpacted by the health technology or service, the proposals to be\nconsidered by the committee, and the systematic evidence-based\nassessment prepared in accordance with this subdivision. The committee\nshall allow interested parties a reasonable opportunity to make an oral\npresentation to the committee related to the health technology or\nservice to be reviewed and to submit written information. The committee\nshall consider any information provided by any interested party,\nincluding, but not limited to, health care providers, health care\nfacilities, patients, consumers and manufacturers. For all health\ntechnologies or services selected for review, the department shall\nconduct or commission a systematic evidence-based assessment of the\nhealth technology's or service's safety and clinical efficacy. The\nassessment shall use established systematic review elements, study\nquality assessment, and data synthesis. Upon completion, the systematic,\nevidence-based assessment shall be made available to the public.\n 6. The commissioner shall provide notice of any coverage\nrecommendations developed by the committee by making such information\navailable on the department's website. Such public notice shall include:\na summary of the deliberations of the committee; a summary of the\npositions of those making public comments at meetings of the committee\nand any safety and health outcomes data submitted by any interested\nparty; the response of the committee to those comments, if any; the\nclinical evidence upon which the committee bases its recommendations;\nand the findings and recommendations of the committee including a final\nevidence-based systematic assessment.\n 7. The commissioner shall provide public notice on the department's\nwebsite of the committee's recommendation and the department's final\ndetermination, including: the nature of the determination; an analysis\nof the impact of the department's determination on the state Medicaid\nplan populations and providers; and the projected fiscal impact to the\nstate Medicaid program.\n 8. The recommendations of the committee, made pursuant to this\nsection, shall be based on a review of the evidence presented to the\ncommittee, including the clinical effectiveness, patient outcomes,\nimpact on at risk and underserved populations, and safety. The committee\nshall review previous recommendations of the committee as new evidence\nbecomes available and permit oral presentations and the submission of\nnew evidence at any committee meeting. Such review shall occur pursuant\nto the procedure established in subdivisions five and six of this\nsection. The department may alter or revoke the final determination\nafter such review pursuant to the procedure established in subdivision\nseven of this section.\n 9. The department shall provide administrative support to the\ncommittee.\n