Bill Text: NY A06898 | 2023-2024 | General Assembly | Introduced

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Bill Title: Provides that the failure by the utilization review agent to make a determination within certain time periods shall be deemed to be an approval of the health care services.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced) 2024-01-03 - referred to insurance [A06898 Detail]

Download: New_York-2023-A06898-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          6898

                               2023-2024 Regular Sessions

                   IN ASSEMBLY

                                       May 8, 2023
                                       ___________

        Introduced by M. of A. WEPRIN -- read once and referred to the Committee
          on Insurance

        AN ACT to amend the public health law and the insurance law, in relation
          to  providing that the failure by the utilization review agent to make
          a determination within certain time periods shall be deemed to  be  an
          approval of the health care services

          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:

     1    Section 1. Subdivision 7 of section 4903 of the public health law,  as
     2  amended  by  chapter  512  of  the  laws  of 2016, is amended to read as
     3  follows:
     4    7. Failure by the utilization review agent  to  make  a  determination
     5  within the time periods prescribed in this section shall be deemed to be
     6  an  [adverse  determination subject to appeal pursuant to section forty-
     7  nine hundred four of this title, provided, however,  that]  approval  of
     8  the health care services in question and failure to meet such time peri-
     9  ods  for a step therapy protocol as defined in subdivision seven-f-three
    10  of section forty-nine hundred of this title or a step  therapy  protocol
    11  override  determination  pursuant  to  subdivisions three-a, three-b and
    12  three-c of this section shall be deemed to be an override  of  the  step
    13  therapy protocol.
    14    §  2.  Subsection (g) of section 4903 of the insurance law, as amended
    15  by chapter 512 of the laws of 2016, is amended to read as follows:
    16    (g) Failure by the utilization review agent to  make  a  determination
    17  within the time periods prescribed in this section shall be deemed to be
    18  an  [adverse  determination  subject  to appeal pursuant to section four
    19  thousand nine hundred four  of  this  title,  provided,  however,  that]
    20  approval  of  the  health  care services in question and failure to meet
    21  such time periods for a step therapy protocol as defined  in  subsection
    22  (g-9)  of  section  forty-nine  hundred  of this title or a step therapy
    23  protocol override determination pursuant to subsections (c-1), (c-2) and

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD08337-01-3
        A. 6898                             2

     1  (c-3) of this section shall be deemed to be  an  override  of  the  step
     2  therapy protocol.
     3    §  3.  This  act shall take effect on the thirtieth day after it shall
     4  have become a law.