NY State Senate Bill 2021-S6920

Senate Bill S6920

2021-2022 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

download bill text pdf

Archive: Last Bill Status - In Senate Committee Rules Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Actions

View Actions

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jun 03, 2022	committed to rules
May 17, 2022	advanced to third reading
May 16, 2022	2nd report cal.
May 11, 2022	1st report cal.1336
Jan 05, 2022	referred to health
May 20, 2021	referred to health

Votes

- May 9, 2022 - Health Committee Vote
  S6920
  
  13
  
  Aye
  
  0
  
  Nay
  
  1
  
  Aye with Reservations
  
  0
  
  Absent
  
  1
  
  Excused
  
  0
  
  Abstained
  - - Health Committee Vote: May 9, 2022
      
      aye (13)
      
      Biaggi
      
      Boyle
      
      Cleare
      
      Gallivan
      
      Hoylman-Sigal
      
      Kaminsky
      
      May
      
      Rath III
      
      Rivera
      
      Ryan
      
      Salazar
      
      Stec
      
      Thomas
      
      aye wr (1)
      
      Oberacker
      
      excused (1)
      
      Brouk

co-Sponsors

2021-S6920 (ACTIVE) - Details

Current Committee:: Senate Rules
Law Section:: Public Health Law
Laws Affected:: Amd §4903, Pub Health L; amd §4903, Ins L
Versions Introduced in 2023-2024 Legislative Session:: S3402

2021-S6920 (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.

2021-S6920 (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S6920

SPONSOR: BRESLIN
 
TITLE OF BILL:

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

 
PURPOSE OR GENERAL IDEA OF BILL:

This purpose of this bill is to ensure timely determinations by health
plans regarding the provision of healthcare services, which would miti-
gate potential delays in patient care.

 
SUMMARY OF SPECIFIC PROVISIONS:

This bill would amend subdivision 7 of section 4903 of the public health
law and subsection (g) of section 4903 of the insurance law to provide
that failure by a utilization review agent to make a determination with-
in required time periods would be deemed to be an approval of the health

care service in question.

 
JUSTIFICATION:

Under current law, when a healthcare provider submits a request for
services for a health plan's enrollee, a lack of response from the
health plan results in a denial. This requires healthcare providers to
engage in a cumbersome process to appeal the denial and receive the
payment rightfully owed to the provider. Treating a non-response from a
health plan as a denial rather than as an approval, wrongly shifts the
burden to providers and forces them to appeal from silence. Notably,
after potentially lengthy and costly reviews and delays, the result is
routinely the validation of services.

Additionally, there are established timeframes within which utilization
review determinations must be made. Allowing plans to deny services by
simply not making a determination within the required timeframes creates
an incentive for insurers to delay or ignore requests. Failure of a plan
to respond to a timely claim submission should be treated as an
approval, rather than a denial.  This bill would help to ensure utiliza-
tion review determinations are made in a timely manner, and would reduce
potential delays in treatment that can result in unnecessary negative
consequences in patient care.

 
PRIOR LEGISLATIVE HISTORY:

New bill

 
FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
This act shall take effect on the thirtieth day after it shall have
become a law.

2021-S6920 (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   6920
 
                        2021-2022 Regular Sessions
 
                             I N  S E N A T E
 
                               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:
 
   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.

                                                            LBD11642-01-1

 S. 6920                             2
 
 (c-3)  of  this  section  shall  be deemed to be an override of the step
 therapy protocol.
   §  3.  This  act shall take effect on the thirtieth day after it shall
 have become a law.

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Senate Bill S6920

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Sponsored By

Neil D. Breslin