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Senate Bill S3402

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 Senate Committee Rules Committee

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2023-S3402 (ACTIVE) - Details

See Assembly Version of this Bill:
A6898
Current Committee:
Senate Rules
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: S4721, A4063

2023-S3402 (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-S3402 (ACTIVE) - Sponsor Memo

2023-S3402 (ACTIVE) - Bill Text download pdf 

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   3402
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                             January 31, 2023
                                ___________
 
 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:
 
   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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