NY State Senate Bill 2023-S3402

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

download bill text pdf

Current 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

Please enter your contact information

First Name

Last Name

Email Address

A valid email address is required.

Home address is used to determine the senate district in which you reside. Your support or opposition to this bill is then shared immediately with the senator who represents you.

Optional services from the NY State Senate:

Create an account. An account allows you to officially support or oppose key legislation, sign petitions with a single click, and follow issues, committees, and bills that matter to you. When you create an account, you agree to this platform's terms of participation.

Include a custom message for your Senator? (Optional)

Enter a message to your senator. Many New Yorkers use this to share the reasoning behind their support or opposition to the bill. Others might share a personal anecdote about how the bill would affect them or people they care about.

Actions

View Actions

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jun 07, 2024	committed to rules
Feb 26, 2024	advanced to third reading
Feb 14, 2024	2nd report cal.
Feb 13, 2024	1st report cal.450
Jan 03, 2024	referred to health
Jun 10, 2023	committed to rules
May 22, 2023	advanced to third reading
May 18, 2023	2nd report cal.
May 17, 2023	1st report cal.1049
Jan 31, 2023	referred to health

Votes

- Feb 13, 2024 - Health Committee Vote
  S3402
  
  14
  
  Aye
  
  1
  
  Nay
  
  0
  
  Aye with Reservations
  
  0
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  - - Health Committee Vote: Feb 13, 2024
      
      aye (14)
      
      Brouk
      
      Felder
      
      Gallivan
      
      Hoylman-Sigal
      
      Mannion
      
      Martins
      
      May
      
      Myrie
      
      Rhoads
      
      Rivera
      
      Salazar
      
      Stec
      
      Thomas
      
      Webb
      
      nay (1)
      
      Ashby
  May 17, 2023 - Health Committee Vote
  S3402
  
  14
  
  Aye
  
  1
  
  Nay
  
  0
  
  Aye with Reservations
  
  0
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  - - Health Committee Vote: May 17, 2023
      
      aye (14)
      
      Brouk
      
      Felder
      
      Gallivan
      
      Hoylman-Sigal
      
      Mannion
      
      Martins
      
      May
      
      Myrie
      
      Rhoads
      
      Rivera
      
      Salazar
      
      Stec
      
      Thomas
      
      Webb
      
      nay (1)
      
      Ashby

co-Sponsors

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 2021-2022 Legislative Session:: S6920

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

                                 
BILL NUMBER: S3402

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:

2021-22: S6920

 
FISCAL IMPLICATIONS:

None.

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

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

 S. 3402                             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.

Comments

Open Legislation is a forum for New York State legislation. All comments are subject to review and community moderation is encouraged.

Comments deemed off-topic, commercial, campaign-related, self-promotional; or that contain profanity, hate or toxic speech; or that link to sites outside of the nysenate.gov domain are not permitted, and will not be published. Attempts to intimidate and silence contributors or deliberately deceive the public, including excessive or extraneous posting/posts, or coordinated activity, are prohibited and may result in the temporary or permanent banning of the user. Comment moderation is generally performed Monday through Friday. By contributing or voting you agree to the Terms of Participation and verify you are over 13.

Create an account. An account allows you to sign petitions with a single click, officially support or oppose key legislation, and follow issues, committees, and bills that matter to you. When you create an account, you agree to this platform's terms of participation.

Senate Bill S3402

Share this bill

Sponsored By

Neil D. Breslin