Bill > S07297

This bill modifies existing laws related to utilization review (UR) programs in health care, focusing on improving clinical review criteria and pre-authorization processes. The bill requires utilization review agents to use evidence-based and peer-reviewed clinical review criteria that consider the needs of typical patient populations and diagnoses. It shortens the timeframe for pre-authorization determinations from three business days to seventy-two hours, and requires more detailed notifications to patients or insureds about their health care services. The bill also mandates that pre-authorization approvals be valid for the full duration of a prescription (including refills) and the entire treatment period for a specific condition as requested by the healthcare provider. Additionally, the notifications must now include specifics about in-network/out-of-network services, potential patient financial responsibility, and how patients can estimate out-of-pocket costs for out-of-network services. These changes apply to both public health and insurance law, aiming to increase transparency and efficiency in healthcare service approvals. The bill will take effect 180 days after becoming law.

Health and Social Services

https://www.nysenate.gov/legislation/bills/2025/S7297