New York A03789 amends health care laws to enhance utilization review standards.

New York A03789 amends the public health law and insurance law to improve utilization review program standards. It mandates the use of evidence-based and peer-reviewed clinical review criteria for health care services requiring pre-authorization. The bill also addresses prescription drug formulary changes and pre-authorization for specific health care services. It sets timeframes for making utilization review determinations and providing notice to insured individuals and their health care providers.

New York A03789 amends health care laws to enhance utilization review standards.

New York A03789 amends the public health law and insurance law to improve utilization review program standards. It mandates the use of evidence-based and peer-reviewed clinical review criteria for health care services requiring pre-authorization. The bill also addresses prescription drug formulary changes and pre-authorization for specific health care services. It sets timeframes for making utilization review determinations and providing notice to insured individuals and their health care providers.