NY A09835

Establishes a 60-day deadline for claimants to request review of denied claims or prior authorization requests, with options for court review or administrative review through commissioner regulations.

Expands the definition of "qualifying health care costs" to include habilitation services, respite care, home modifications, vehicle modifications, and transportation for health care appointments.

Changes reimbursement calculation to use the eightieth percentile of charges from a nonprofit benchmarking database maintained by the superintendent of financial services; if unavailable, requires reimbursement at no less than 130 percent of Medicaid or Medicare rates.

Prohibits regulations from denying coverage for qualifying health care costs solely because they may benefit other household members in addition to the patient.

Creates a consumer and stakeholder workgroup co-chaired by the commissioner and superintendent of financial services to review and provide input on proposed regulations under the medical indemnity fund.