Bill > S04721

This bill amends the public health law and insurance law to change how utilization review agents (URAs) handle health care service approvals and step therapy protocols. Specifically, if a URA fails to make a determination within the prescribed time periods, it will now be automatically considered an approval of the requested health care services, rather than an adverse determination subject to appeal. For step therapy protocols (a process where patients must try less expensive or alternative treatments before more complex or costly treatments), a URA's failure to respond within the specified timeframe will be deemed an override of the protocol. Additionally, a URA's failure to comply with step therapy protocol requirements can be grounds for granting a protocol override, unless fraud is involved. The bill aims to expedite the healthcare service approval process and provide more timely access to needed medical treatments by creating clear consequences for URAs that do not respond within established timeframes.

Health and Social Services

https://www.nysenate.gov/legislation/bills/2025/S4721