New York Senate Bill S05710

New York 2025-2026 Regular Session

• Introduced: 2/28/25
• Refer: 2/28/25
• Refer: 1/7/26

Caption

Requires any regulation that mandates prior authorization to establish a mechanism for submission of requests for prior authorization by health care providers directly to the medical indemnity fund; requires the medical indemnity fund administrator to notify qualified plaintiffs which costs are qualifying health care costs to be paid from the fund and which are not within a reasonably prompt period of time.

Summary

S05710 amends New York’s Public Health Law provisions governing the Medical Indemnity Fund, which pays certain health care costs for qualified plaintiffs in medical malpractice cases involving birth-related neurological injuries. The bill adds a requirement that, when prior authorization is required for a covered service or payment, the regulation must allow health care providers to submit prior authorization requests directly to the fund and must provide a prompt administrative review process for denials. The bill also requires the fund administrator to notify qualified plaintiffs, within a reasonably prompt period, which submitted costs are qualifying health care costs payable from the fund and which are not. In addition, it changes the fund’s financing and oversight rules by requiring updated actuarial calculations, quarterly actuarial reviews, public posting of those calculations, and a new funding trigger beginning in fiscal year 2025-2026 to keep liabilities below 80 percent of assets. It also directs that the fund continue accepting new enrollments during the 2025-2026 fiscal year, even if the liability threshold would otherwise pause enrollments.

Impact

The bill would amend sections 2999-i and 2999-j of the Public Health Law, affecting the administration, enrollment, and payment procedures of the Medical Indemnity Fund. It would impose new duties on the fund administrator and the Department of Health to process prior authorization requests, issue timely cost determinations, conduct and publish actuarial analyses, and manage fund solvency through a revised deposit formula and enrollment rules. The changes primarily affect health care providers, qualified plaintiffs enrolled in the fund, and the state officials responsible for administering and funding the program.

Sentiment

Based on the bill text and available context, the measure appears to be a technical and administrative update intended to improve transparency, timeliness, and access to the Medical Indemnity Fund rather than a broadly controversial policy change. The caption suggests a focus on streamlining prior authorization and clarifying payment determinations, which are generally framed as operational improvements. No committee transcript or vote record was provided, so there is no recorded public debate or roll-call sentiment to assess beyond the bill’s apparent administrative purpose.

Contention

The main points of potential contention are likely to be the new direct-submission requirement for prior authorization, the obligation to notify plaintiffs promptly about covered and non-covered costs, and the revised funding rules that require additional deposits to keep liabilities below 80 percent of assets. Those provisions could raise concerns for fund administrators and state budget officials about workload, timing, and fiscal exposure, while health care providers and plaintiffs are likely to support faster decisions and clearer payment determinations. The provision allowing the fund to continue accepting new enrollments in fiscal year 2025-2026 may also be debated if the fund is near its liability threshold.