NY S08844

Removes distinction between Title One and Title Two definitions of "clinical peer reviewer" and applies a single definition across all utilization review and external appeal provisions in both Public Health Law and Insurance Law.

Requires physicians serving as clinical peer reviewers to possess a current non-restricted license under Article 131 of Education Law, be board certified or eligible in the same/similar specialty, have at least five years of practicing experience in that specialty, and be knowledgeable about the service or treatment under review.

Requires non-physician health care professionals to possess a current non-restricted license or certification under Title Eight of Education Law, be credentialed by appropriate national accrediting bodies, have at least five years of practicing experience, be knowledgeable about the service or treatment, and be clinically supported by a physician where applicable to their scope of practice.

Adds specific qualifications for clinical peer reviewers evaluating substance use disorder treatment and mental health condition determinations, requiring them to specialize in behavioral health and have experience in delivering those respective courses of treatment.

Takes effect on the same date as the 2019 law provisions it amends (Chapter 57, Part BB, Subpart A), or 90 days after becoming law, whichever is later.