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.
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.
