2023 New York Laws › SOS - Social Services › Article 5 - Assistance and Care › Title 11 - Medical Assistance for Needy Persons › 365-D - Medicaid Evidence Based Benefit Review Advisory Committee.

§ 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 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.