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A3895Assembly2019-2020 Session

Ban Conflicted Review Agents

Official title

“Promotes transparency and equity in the utilization review process by ensuring that agents are independent, having no existing relationships with the reviewed entity”

Sponsor Michael DenDekkerAD-34+1 co-sponsorAffects Finance
Status
In Assembly Committee
Insurance
Impact
4/10
Low
Passage
0%

Bill progress

Step 2 of 7

In committee · Insurance

What's happening

This bill prohibits utilization review agents from reviewing entities with which they have significant familial, financial, or professional ties.

Why it matters

  1. Reduces potential conflicts of interest in healthcare decisions. by preventing utilization review agents from assessing entities where they have close family, financial, or professional ties, thereby aiming to ensure that reviews are impartial and based on patient needs rather than personal gain.

  2. Aims to protect patients and providers from biased denials or approvals of care. by making it harder for entities with vested interests to influence the outcome of coverage or treatment authorization decisions.

  3. May enhance trust in the healthcare system. by increasing transparency and accountability in the review process, potentially encouraging fairer outcomes for patients and healthcare providers.

  4. Could impact the operations of insurers and review agencies. by requiring them to vet and monitor their agents for conflicts of interest, possibly introducing new compliance procedures and oversight mechanisms.

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Who cares

Headline styles

Ban Conflicted Review Agents

Plain English, a few words. Used as the page title.

Sponsors

Primary sponsor
Michael DenDekker

Assembly Member · Assembly District 34

1 Co-sponsor

1 Multi-sponsor

History

  1. Referred to insurance
  2. Referred to insurance

Full text

1 pageUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗

STATE OF NEW YORK

3895

2019-2020 Regular Sessions

IN ASSEMBLY

January 31, 2019

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.

LBD07827-01-9

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.