HB 248 Summary

• Requires health carriers and utilization review organizations to certify or deny prospective review requests within two business days for non-urgent services and one business day for urgent services, with failure to comply resulting in automatic certification.

• Prohibits prospective review for pre-hospital transportation and emergency services, and allows 24 hours (or until next business day if holiday/weekend) for notification of emergency admissions.

• Mandates that adverse determination notices include the reviewing provider's credentials, clinical review criteria applied, appeal procedures, and instructions for overriding step therapy or fail-first protocols.

• Prohibits retrospective denial of certified services for 45 working days and voids any contractual waiver of prospective review protections.

• Requires health carriers to publish prospective review requirements and statistics on certifications/denials organized by physician specialty, medication/procedure, indication, and denial reason, with 60 days' notice before implementing new or amended review requirements.