New YorkRelates to downcoding on initial review and audits reversing or altering medical necessity determinations
What it does
Ensures the decision to downcode an insurance claim is recognized as an adverse determination; prohibits health plans from reversing or altering medical necessity determinations made by a utilization review agent or external appeals agent as a result of an audit of claims.
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Where it stands
- Introduced
- Passed 1st Chamber
- Passed 2nd Chamber
- To Governor
- Became Law
Looking ahead
No hearings or votes scheduled.
History
- 2026
- Jan 7REFERRED TO INSURANCELatest
- 2025
- Jan 30REFERRED TO INSURANCEIntroduced