A bill for an act relating to utilization review organizations’ use of artificial intelligence, prior authorization determinations and exemptions, and audits, and including applicability provisions.

Summary

The measure sets rules for how utilization review organizations can use artificial‑intelligence algorithms in prior‑authorization reviews and requires a qualified physician or clinical peer to make any denial or downgrade, with written explanations. It also exempts cancer‑screening requests that follow national guidelines and urgent inpatient diagnoses deemed life‑threatening from prior‑authorization requirements, and it establishes notice and timing standards for pre‑payment audits. The bill targets health carriers, insurers, and review organizations, aiming to increase transparency and protect patients, but it was withdrawn before becoming law.

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