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.
Summary
Bill S04721 amends the public health law and the insurance law in New York to establish that if a utilization review agent fails to make a determination regarding health care services within specified timeframes, such failure will be considered as an approval of those services. This change aims to streamline the approval process for necessary health care services and ensure timely access for patients. Additionally, the bill addresses step therapy protocols, stating that non-compliance by the utilization review agent will also be deemed as an override of such protocols, facilitating patient access to prescribed treatments without unnecessary delays.
Impact
The bill's passage would significantly impact the operations of utilization review agents and health insurance providers in New York. By deeming failures to act within specified timeframes as approvals, it would reduce the barriers patients face in receiving timely health care services. This could lead to changes in how health insurance companies manage their review processes and could potentially increase the number of approved claims for health care services, thereby affecting the overall healthcare delivery system in the state.
Sentiment
The sentiment surrounding Bill S04721 appears to be generally positive, as it seeks to enhance patient access to necessary health care services by reducing delays caused by utilization review processes. However, there may be concerns from insurance companies regarding the implications of automatic approvals, which could lead to increased costs or changes in their operational protocols.
Contention
Notable points of contention may arise from insurance companies and utilization review agents who might argue that the bill could undermine their ability to conduct thorough reviews of health care services. They may express concerns about the potential for increased costs and the need for a balance between patient access and the integrity of the review process. On the other hand, advocates for patient rights and access to healthcare may strongly support the bill, emphasizing the importance of timely care.
Same As
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.
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.
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.
Relates to the use of artificial intelligence by insurers and clinical peer reviewers for utilization review; establishes additional notice requirements for adverse determinations.
Relates to the use of artificial intelligence by insurers and clinical peer reviewers for utilization review; establishes additional notice requirements for adverse determinations.
Hospital and Medical Services Utilization Review Act; requiring utilization review organization that uses AI to adhere to requirements; prohibiting AI from making certain determinations. Effective date.