Bill Text: NY S06920 | 2021-2022 | 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 2-0)

Status: (Introduced - Dead) 2022-06-03 - COMMITTED TO RULES [S06920 Detail]

Download: New_York-2021-S06920-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          6920

                               2021-2022 Regular Sessions

                    IN SENATE

                                      May 20, 2021
                                       ___________

        Introduced  by  Sen. BRESLIN -- read twice and ordered printed, and when
          printed to be committed to the Committee on Health

        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.
                                                                   LBD11642-01-1
        S. 6920                             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.