SB 173

As amended 1/15/2026: - Prohibits the state employee health plan, Medicaid, and insurers from imposing a time limit or on the amount of anesthesia for a medical procedure ot otherwise restricting or excluding coverage or payment of anesthesia time. - Modifies the definition of "charity care" and "community benefits" for hospital reporting requirements. - Requires additional reporting of information by nonprofit hospitals to the Department of Health, including information on the hospital's charity care program, value of tax exemptions, and net revenue from participation in 340B. - Requires the report to be posted on the nonprofit hospital's website and the Department's website, increases the penalty for failure to file the report, and changes the time frame in which the penalty may be assessed. - Requires a clinical peer to disclose certain information for a peer-to-peer review of an adverse utilization review determination. - Prohibits a utilization review entity from using artificial intelligence as the primary means for making adverse determinations. - Prohibits health insurers from engaging in certain claims downcoding practices and establishes conditions for downcoding a claim. - Prohibits a health insurer from using an automated process, system, or tool, including artificial intelligence, to downcode a claim. - Prohibits an insurer or PBM from designating a prescription drug as a specialty drug unless the drug is a limited distribution that requires special handling and is not commonly carried at retail pharmacies or oncology clinics or practices. - NOTE: 1/15/2026 amendment removed the following provisions: - Prohibits a health carrier from contracting with a pharmacy benefit manager (PBM) in which it has an ownership interest and prohibits a PBM from having an ownership interest in a pharmacy. - Removes the requirement for a provider referral to receive physical therapy, including for spinal manipulation and sharp debridement.