· NY legislature · 2025-2026

Relates to downcoding on initial review and audits reversing or altering medical necessity determinations

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.

Sponsor

David Weprin (D-NY)

Introduced

2025-01-30

Policy area

Health

Latest action

REFERRED TO INSURANCE