Bill > A04063

This bill modifies provisions in the New York Public Health Law and Insurance Law regarding utilization review agents (URAs), which are organizations that review the medical necessity and appropriateness of healthcare services. Currently, when a URA fails to make a determination within prescribed time periods, it was considered an adverse determination subject to appeal. The bill changes this so that if a URA does not make a determination within the specified timeframes, it will instead be automatically considered an approval of the requested healthcare services. Additionally, for step therapy protocols (a process where patients must try less expensive treatments before more costly ones), failure to meet time periods will now be deemed an override of the protocol. The bill aims to expedite healthcare service approvals and provide more transparency and accountability for utilization review agents by creating automatic approvals when they do not respond within established timeframes. The changes will take effect simultaneously with another related law (Chapter 641 of the Laws of 2024) to ensure consistent implementation across different sections of New York state law.

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https://www.nysenate.gov/legislation/bills/2025/A4063