Bill
Bill > A03789
NY A03789
NY A03789Relates to utilization review program standards; requires use of evidence-based and peer reviewed clinical review criteria; relates to prescription drug formulary changes and pre-authorization for certain health care services.
summary
Introduced
01/30/2025
01/30/2025
In Committee
05/28/2025
05/28/2025
Crossed Over
Passed
Dead
Introduced Session
2025-2026 General Assembly
Bill Summary
AN ACT to amend the public health law and the insurance law, in relation to utilization review program standards and pre-authorization of health care services
AI Summary
This bill modifies existing laws in New York related to utilization review programs and pre-authorization for health care services by making several key changes. First, it requires that clinical review criteria used by health care plans be evidence-based and peer-reviewed, taking into account the needs of typical patient populations and diagnoses. Second, it reduces the time frame for utilization review determinations from three business days to seventy-two hours, with expedited one-business-day reviews for inpatient rehabilitation services. The bill also mandates that pre-authorization notices include specific details such as whether services are in-network or out-of-network, potential out-of-pocket costs, and the dollar amount the health care plan will pay for out-of-network services. Additionally, the bill stipulates that pre-authorization approvals will be valid for the full duration of a prescription (including refills) and the entire course of treatment for a specific condition as requested by the healthcare provider. These changes aim to provide more transparency, efficiency, and patient-centered care in health care service approvals. The bill will take effect 180 days after becoming law.
Committee Categories
Business and Industry
Sponsors (47)
David Weprin (D)*,
Joe Angelino (R),
Didi Barrett (D),
Scott Bendett (R),
Ken Blankenbush (R),
Alex Bores (D),
Karl Brabenec (R),
Marianne Buttenschon (D),
Robert Carroll (D),
Sarah Clark (D),
William Colton (D),
Catalina Cruz (D),
Brian Cunningham (D),
Maritza Davila (D),
Dave DiPietro (R),
Harvey Epstein (D),
Jeff Gallahan (R),
Andrew Hevesi (D),
Rebecca Kassay (D),
Paula Kay (D),
Anna Kelles (D),
Charles Lavine (D),
Dana Levenberg (D),
Jen Lunsford (D),
Donna Lupardo (D),
Bill Magnarelli (D),
Karen McMahon (D),
Demond Meeks (D),
Amy Paulin (D),
Sam Pirozzolo (R),
Steven Raga (D),
Phil Ramos (D),
Karines Reyes (D),
Linda Rosenthal (D),
Angelo Santabarbara (D),
Nader Sayegh (D),
Rebecca Seawright (D),
Sarahana Shrestha (D),
Jo Anne Simon (D),
Matt Simpson (R),
Phil Steck (D),
Al Stirpe (D),
Mike Tannousis (R),
Al Taylor (D),
Aron Wieder (D),
Jaime Williams (D),
Carrie Woerner (D),
Last Action
amend and recommit to rules 3789a (on 06/09/2025)
Official Document
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