New York A04063 amends the public health law to deem a utilization review agent's failure to make a determination within specified time periods as.

New York A04063 amends the public health law to establish that if a utilization review agent fails to make a determination within certain time periods, it shall be deemed an approval of the health care services. This change applies to step therapy protocols and override determinations. The bill also amends the insurance law to clarify that a utilization review agent's failure to comply with step therapy protocol requirements can be a basis for granting an override, absent fraud. The changes are designed to ensure timely access to necessary health care services.

New York A04063 amends the public health law to deem a utilization review agent's failure to make a determination within specified time periods as.

New York A04063 amends the public health law to establish that if a utilization review agent fails to make a determination within certain time periods, it shall be deemed an approval of the health care services. This change applies to step therapy protocols and override determinations. The bill also amends the insurance law to clarify that a utilization review agent's failure to comply with step therapy protocol requirements can be a basis for granting an override, absent fraud. The changes are designed to ensure timely access to necessary health care services.