Loading chat...
NY S07297
Bill
Status
4/9/2025
Primary Sponsor
Brad Hoylman-Sigal
Click for details
AI Summary
-
Requires utilization review agents to use recognized evidence-based and peer-reviewed clinical review criteria that account for typical patient populations and diagnoses when making coverage determinations
-
Shortens the deadline for pre-authorization decisions from three business days to 72 hours for health care services requiring prior approval
-
Mandates that pre-authorization approvals remain valid for the full duration of a prescription (including authorized refills) and for the duration of treatment for a specific condition as requested by the provider
-
Applies these requirements to both public health law and insurance law, covering enrollees in health plans and insured individuals
-
Takes effect 180 days after becoming law
Legislative Description
Relates to utilization review program standards; requires use of evidence-based and peer reviewed clinical review criteria; relates to prescription drug formulary changes and pre-authorization for certain health care services.
Last Action
COMMITTED TO RULES
6/13/2025