New York S09651 amends health insurance laws to require utilization review agents to use evidence-based and peer-reviewed clinical criteria for.

New York S09651 amends the public health law and the insurance law to enhance the standards for utilization review programs. The bill mandates that utilization review agents must use written clinical review criteria developed under a utilization review plan. These criteria must be evidence-based and peer-reviewed, taking into account typical patient populations and diagnoses. The bill also sets specific timelines for making pre-authorization determinations and notifying enrollees and providers. For urgent cases, decisions must be made within one business day.

New York S09651 amends health insurance laws to require utilization review agents to use evidence-based and peer-reviewed clinical criteria for.

New York S09651 amends the public health law and the insurance law to enhance the standards for utilization review programs. The bill mandates that utilization review agents must use written clinical review criteria developed under a utilization review plan. These criteria must be evidence-based and peer-reviewed, taking into account typical patient populations and diagnoses. The bill also sets specific timelines for making pre-authorization determinations and notifying enrollees and providers. For urgent cases, decisions must be made within one business day.