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S 4721

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

2025 Regular Session Introduced by Pat Fahy

Bill S 4721 ensures health care services are automatically approved if utilization review agents fail to decide within a set timeframe, speeding up patient access to care.

REFERRED TO HEALTH
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Bill Summary · S 4721

Summary of Bill S 4721

Bill Information

  • Bill Number: S 4721
  • Title: 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
  • Status: Referred to Health
  • Introduced: February 12, 2025
  • Classification: Bill

Purpose and Intent

Bill S 4721 aims to streamline the process of health care service approvals by establishing a clear timeline for utilization review agents to make determinations. If a decision is not made within the specified time frame, the bill stipulates that the health care services in question will automatically be considered approved. This legislation seeks to reduce delays in patient care and enhance access to necessary medical services.

Key Provisions

  • Automatic Approval: The bill mandates that if a utilization review agent fails to make a determination regarding health care services within a defined period, the services will be deemed approved.
  • Time Frames: While the specific time frames for determinations are not detailed in the provided information, the bill implies that these will be established to ensure timely responses from review agents.
  • Impact on Utilization Review Agents: The bill places a responsibility on utilization review agents to adhere to the established timelines, thereby potentially increasing their operational efficiency.

Who Would Be Affected

  • Patients: Individuals seeking health care services would benefit from reduced waiting times for approvals, leading to quicker access to necessary treatments.
  • Health Care Providers: Medical professionals and facilities may experience fewer delays in service approvals, allowing for more timely patient care.
  • Utilization Review Agents: These entities will need to adjust their processes to comply with the new requirements, which may involve changes in staffing or operational procedures.

Procedural Aspects

  • Current Status: As of February 12, 2025, the bill has been referred to the Health Committee for further consideration.
  • Related Legislation: This bill is related to prior-session bills S 6920 and S 3402, as well as a companion bill A 4063, indicating ongoing legislative interest in the topic of utilization review processes.

Conclusion

Bill S 4721 represents a significant step towards improving the efficiency of health care service approvals by ensuring that delays in determinations by utilization review agents do not hinder patient access to care. By establishing automatic approval in the absence of timely decisions, the bill aims to enhance the overall health care experience for patients and providers alike. Further discussions and amendments may occur as the bill progresses through the legislative process.

Compiled from official sources — confirm details with the bill’s official record.

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