Establishes a pilot program to evaluate the use of retrospective utilization review in the state employee group insurance program.

The bill establishes a utilization review pilot program for the state employee group insurance program, running from January 1, 2026, to December 31, 2030. The program will evaluate the efficacy, costs, and operation of retrospective utilization review compared to prior authorization. Health carriers must conduct quality and payment audits of retrospective utilization review determinations. The commissioner of management and budget may terminate the pilot program if it negatively impacts enrollee access to care or state costs.

Establishes a pilot program to evaluate the use of retrospective utilization review in the state employee group insurance program.

The bill establishes a utilization review pilot program for the state employee group insurance program, running from January 1, 2026, to December 31, 2030. The program will evaluate the efficacy, costs, and operation of retrospective utilization review compared to prior authorization. Health carriers must conduct quality and payment audits of retrospective utilization review determinations. The commissioner of management and budget may terminate the pilot program if it negatively impacts enrollee access to care or state costs.