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Assembly Bill A6898

2023-2024 Legislative Session

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

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Archive: Last Bill Status - In Assembly Committee

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2023-A6898 (ACTIVE) - Details

See Senate Version of this Bill:
S3402
Current Committee:
Assembly Insurance
Law Section:
Public Health Law
Laws Affected:
Amd §4903, Pub Health L; amd §4903, Ins L
Versions Introduced in Other Legislative Sessions:
2021-2022: S6920
2025-2026: A4063, S4721

2023-A6898 (ACTIVE) - Summary

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.

2023-A6898 (ACTIVE) - Bill Text download pdf 

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   6898
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                                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:
 
   Section 1. Subdivision 7 of section 4903 of the public health law,  as
 amended  by  chapter  512  of  the  laws  of 2016, is amended to read as
 follows:
   7. Failure by the utilization review agent  to  make  a  determination
 within the time periods prescribed in this section shall be deemed to be
 an  [adverse  determination subject to appeal pursuant to section forty-
 nine hundred four of this title, provided, however,  that]  APPROVAL  OF
 THE HEALTH CARE SERVICES IN QUESTION AND failure to meet such time peri-
 ods  for a step therapy protocol as defined in subdivision seven-f-three
 of section forty-nine hundred of this title or a step  therapy  protocol
 override  determination  pursuant  to  subdivisions three-a, three-b and
 three-c of this section shall be deemed to be an override  of  the  step
 therapy protocol.
   §  2.  Subsection (g) of section 4903 of the insurance law, as amended
 by chapter 512 of the laws of 2016, is amended to read as follows:
   (g) Failure by the utilization review agent to  make  a  determination
 within the time periods prescribed in this section shall be deemed to be
 an  [adverse  determination  subject  to appeal pursuant to section four
 thousand nine hundred four  of  this  title,  provided,  however,  that]
 APPROVAL  OF  THE  HEALTH  CARE SERVICES IN QUESTION AND failure to meet
 such time periods for a step therapy protocol as defined  in  subsection
 (g-9)  of  section  forty-nine  hundred  of this title or a step therapy
 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

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