What's happening
This bill prohibits utilization review agents from reviewing entities with which they have material familial, financial, or professional affiliations.
Why it matters
Reduces conflicts of interest in healthcare reviews. by preventing utilization review agents from making decisions about entities (such as hospitals, clinics, or providers) where they or their close associates have significant personal, financial, or professional ties.
Aims to improve trust in coverage decisions. by ensuring that utilization reviews—which influence whether medical treatments are approved or denied—are conducted impartially, not skewed by relationships or potential personal gain.
Could lead to better patient outcomes. by minimizing the risk that reviews are biased in favor of affiliated providers or insurers, potentially protecting patients from inappropriate denials or approvals of care.
May require insurers and review agencies to increase transparency. about their affiliations and relationships, prompting stricter oversight and potentially more rigorous internal compliance processes.
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Who cares
Headline styles
Stop Biased Health Reviews
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Referred to insurance
- Referred to insurance
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Ban Biased Utilization Reviews
In Senate Committee · Health · Sponsor Jesse Hamilton
Full text
1 pageUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
3232
2017-2018 Regular Sessions
IN ASSEMBLY
January 27, 2017
Introduced by M. of A. DenDEKKER -- read once and referred to the Committee on Insurance
AN ACT to amend the public health law and the insurance law, in relation to utilization review agents
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Section 4905 of the public health law is amended by adding a new subdivision 16 to read as follows:
16. A utilization review agent shall not conduct a review of any entity in which it has "material familial affiliation", "material financial affiliation" or "material professional affiliation".
§ 2. Section 4905 of the insurance law is amended by adding a new subsection (p) to read as follows:
(p) A utilization review agent shall not conduct a review of any entity in which it has "material familial affiliation", "material financial affiliation" or "material professional affiliation".
§ 3. This act shall take effect immediately.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD00740-01-7
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.