New York S05241 mandates that certain utilization review determinations must align with medical and scientific evidence, and includes mental health.

New York S05241 amends the insurance law to ensure that certain utilization review determinations are made using evidence-based and peer-reviewed clinical review criteria. These criteria must be consistent with medical and scientific evidence and appropriate to the age of the patient. The bill also specifies that emergency services, including those for mental health and substance use disorders, should not be subject to prior authorization or denied on retrospective review. This applies to services provided by mobile crisis response teams or crisis receiving or stabilization centers.

New York S05241 mandates that certain utilization review determinations must align with medical and scientific evidence, and includes mental health.

New York S05241 amends the insurance law to ensure that certain utilization review determinations are made using evidence-based and peer-reviewed clinical review criteria. These criteria must be consistent with medical and scientific evidence and appropriate to the age of the patient. The bill also specifies that emergency services, including those for mental health and substance use disorders, should not be subject to prior authorization or denied on retrospective review. This applies to services provided by mobile crisis response teams or crisis receiving or stabilization centers.