S 1403

Summary

As introduced: - Requires insurance carriers to make publicly available on their website a searchable list of all items, services and medications that require prior authorization. - Requires annual reporting of insurance data regarding approval and denials of prior authorization requests, including request for drug benefits. - Requires adoption of utilization review criteria. - Requires an insurance carrier that uses artificial intelligence in utilization review to base determinations on the insured's medical history or other clinical information and not on a group dataset. - Requires a carrier to pay for services ordered by a treating provider if they are covered under the insured’s plan and meet the carrier’s clinical review criteria. Prohibits denial due to technical errors. - Prohibits retrospectively denying authorization. Requires prompt response to a prior authorization request. Regulates prior authorization process. - Prohibits using artificial intelligence to supplant health care provider decision-making. - Require an algorithm to be fairly and equitably applied. Requires the algorithm to be open to audits. Prohibits the algorithm from causing harm. Prohibits using artificial intelligence to deny, delay, or modify health care services based, in whole or in part, on medical necessity. - Creates a task force to study and issue a report on the use of prior authorization.

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