Summary of SB 00006

• Creates automatic prospective and concurrent review exemptions for health care providers who achieve 90% approval rate on utilization review requests, effective for health care contracts entered into or renewed on or after January 1, 2024.

• Establishes six-month evaluation periods and allows health carriers to rescind exemptions only during January or July based on retrospective review of 5-20 random claims, with independent review available at the health carrier's expense.

• Extends newborn coverage notification deadline from 61 days to 121 days after birth or hospital discharge (whichever is later) for both individual and group health insurance policies.

• Expands step therapy restrictions to prohibit step therapy for drugs treating behavioral health conditions and chronic, disabling or life-threatening conditions (previously limited to stage IV metastatic cancer), with 60-day maximum step therapy duration.

• Prohibits health carriers from requiring prospective or concurrent review of recurring health care services or prescription drugs after initial certification through utilization review, effective October 1, 2023.