Bill Title: Reinserts the provisions of the bill, as amended by House Amendment No. 1, with the following changes. Provides that even if a health care plan or other utilization review program uses an algorithmic automated process in the course of utilization review for medical necessity, the health care plan or other utilization review program shall ensure that only a clinical peer makes any adverse determination based on medical necessity and that any subsequent appeal is processed. Adds the National Committee for Quality Assurance to a provision requiring utilization review programs to certify compliance with certain accreditation entities. Provides that utilization review programs that use algorithmic automated processes to decide whether to render adverse determinations (rather than that use algorithmic automated processes) based on medical necessity in the course of utilization review shall use objective, evidence-based criteria compliant with the accreditation requirements. Makes changes in the definition of "adverse determination". Effective January 1, 2025.

Spectrum: Partisan Bill (Democrat 3-0)

Status: (Passed) 2024-07-19 - Public Act . . . . . . . . . 103-0656 [HB2472 Detail]

Text: Latest bill text (Chaptered) [HTML]

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