NY A04063

Changes the consequence when insurance utilization review agents fail to make coverage decisions within required time periods from an "adverse determination subject to appeal" to an automatic approval of the requested health care services

Amends both the Public Health Law (Section 4903) and Insurance Law (Section 4903) to apply this change consistently across health insurance regulation

Maintains existing provisions that failure to meet time periods for step therapy protocol determinations results in an automatic override of the step therapy requirement

Preserves the rule that utilization review agent non-compliance with step therapy protocol requirements constitutes grounds for granting a protocol override, except in cases of fraud

Takes effect on the same date as Chapter 641 of the Laws of 2024 (the underlying utilization review statute being amended)