§ 2999-j. Payments from the fund. 1. The fund shall be used to pay the\nqualifying health care costs of qualified plaintiffs.\n 2. The provision of qualifying health care costs to qualified\nplaintiffs shall not be subject to prior authorization, except as\ndescribed by the commissioner in regulation; provided, however:\n (a) such regulation shall not prevent qualified plaintiffs from\nreceiving care or assistance that would, at a minimum, be authorized\nunder the medicaid program;\n (b) if any prior authorization is required by such regulation, the\nregulation shall require that requests for prior authorization be\nprocessed within a reasonably prompt period of time and shall identify a\nprocess for prompt administrative review of any denial of a request for\nprior authorization; and\n (c) such regulations shall not prohibit qualifying health care costs\non the grounds that the qualifying health care cost may incidentally\nbenefit other members of the household, provided that whether the\nqualifying health care cost primarily benefits the patient may be\nconsidered.\n 3. In determining the amount of qualifying health care costs to be\npaid from the fund, any such cost or expense that was or will, with\nreasonable certainty, be paid, replaced or indemnified from any\ncollateral source as provided by subdivision (a) of section forty-five\nhundred forty-five of the civil practice law and rules shall not\nconstitute a qualifying health care cost and shall not be paid from the\nfund. For purposes of this title, "collateral source" shall not include\nmedicare or Medicaid.\n * 4. The amount of qualifying health care costs to be paid from the\nfund shall be calculated on the basis of one hundred percent of the\nusual and customary cost. For the purposes of this section, "usual and\ncustomary costs" shall mean the eightieth percentile of all charges for\nthe particular health care service performed by a provider in the same\nor similar specialty and provided in the same geographical area as\nreported in a benchmarking database maintained by a nonprofit\norganization specified by the superintendent of financial services. If\nno such rates are available qualifying health care costs shall be\ncalculated on the basis of no less than one hundred thirty percent of\nMedicaid or Medicare rates of reimbursement, whichever is higher. If no\nsuch rate exists, costs shall be reimbursed as defined by the\ncommissioner in regulation.\n * NB Effective until June 1, 2026\n * 4. The amount of qualifying health care costs to be paid from the\nfund shall be calculated: (a) with respect to services provided in\nprivate physician practices on the basis of one hundred percent of the\nusual and customary rates, as defined by the commissioner in regulation;\nor (b) with respect to all other services, on the basis of Medicaid\nrates of reimbursement or, where no such rates are available, as defined\nby the commissioner in regulation.\n * NB Effective June 1, 2026\n 5. Claims for the payment or reimbursement from the fund of qualifying\nhealth care costs shall be made upon forms prescribed and furnished by\nthe fund administrator in conjunction with regulations establishing a\nmechanism for submission of claims by health care providers directly to\nthe fund, where practicable.\n 6. (a) Every settlement agreement for claims arising out of a\nplaintiff's or claimant's birth related neurological injury subject to\nthis title, and that provides for the payment of future medical expenses\nfor the plaintiff or claimant, shall provide that all payments for\nfuture medical expenses shall be paid in accordance with this title in\nlieu of that portion of the settlement agreement that provides for\npayment of such expenses. The plaintiff's or claimant's future medical\nexpenses shall be paid in accordance with this title. When such a\nsettlement agreement does not so provide, the court shall direct the\nmodification of the agreement to include such term as a c
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