NY S08590

Requires insurers to pay hospital claims at contracted rates within established timeframes, regardless of medical necessity reviews, preauthorization requirements, or documentation policies

Allows payors to request post-payment clinical documentation review within 90 days, limited to 10% of claims paid since the last joint committee meeting (increasable to 15% if over 50% of reviewed claims were billed inappropriately)

Establishes joint committees composed of equal numbers of medical directors/clinicians from both the payor and hospital to conduct quarterly post-payment medical necessity reviews

Requires disputes that cannot be resolved by the joint committee to be forwarded to a mutually agreed-upon independent third-party review agent for binding determination

Takes effect January 1, 2026, and prohibits hospitals from billing patients for services deemed medically unnecessary except for applicable copayments, coinsurance, or deductibles