Vetoed measure proposed clinician review of care denials

Certain health plans would have to approve covered care requests unless a qualified health care professional finds the care not medically necessary, experimental, or investigational. The requests may be for medical or dental care, including prescription drugs, under the covered plans. The professional must have training and expertise to assess the clinical issues and review available medical records. The text bars plans from relying solely on automated tools to deny or change requests, reduce requested coverage, or change coverage for already approved care; automated tools may still approve requests. The rules cover insurers and certain local government self-insurance plans. The insurer rule exempts managed care coverage for Medicaid or the Children’s Health Insurance Program under the specified state contract. If approved, the rules were set to take effect for general purposes on January 1, 2026; preparatory work could begin upon approval.

The Legislature would state a policy encouraging certain clinicians to discuss stem cell treatment and storage options with patients. The encouragement covers physicians, physician assistants, advanced practice registered nurses, and osteopathic physicians in the roles described. The text encourages these discussions; it does not require clinicians to provide stem cell treatment or storage. Clinicians would discuss possible treatment when diagnosing a condition regularly treated with stem cell therapy. Primary care providers would share possible donation, banking, or storage options at a new patient's first visit. If approved, these provisions were set to take effect for general purposes on January 1, 2026; preparatory work could begin upon approval.