Bill > S09651

This bill aims to improve standards for utilization review programs, which are processes used by health insurance companies to determine if a requested medical service or prescription drug is medically necessary and appropriate. Key provisions include requiring that the clinical review criteria used by these programs be based on recognized, evidence-based, and peer-reviewed research, taking into account the needs of typical patient populations and diagnoses. Additionally, the bill modifies the timelines for health plans to make pre-authorization decisions for certain healthcare services, shortening the general timeframe to seventy-two hours and expediting it to twenty-four hours for urgent cases where a patient's health is in serious jeopardy without the recommended services. For inpatient rehabilitation services following a hospital stay, the decision timeframe remains one business day. The bill also clarifies that pre-authorization approvals for prescriptions will be valid for the duration of the prescription, including refills, and for treatment of a specific condition as requested by the healthcare provider.

Health and Social Services

https://www.nysenate.gov/legislation/bills/2025/S9651