Utilization Review Act Passes the Senate


Legislation to help ensure that physicians and their patients have more information regarding what their health insurance covers and the protocols necessary to receive preauthorization approval has been approved by the State Senate. Senate Bill 1142 amends the state’s “Utilization Review Act” by requiring that healthcare insurers, or third party payers, publish or post on the Internet at least the non-proprietary portion of the standards so physicians can know the rules of the game beforehand.

The bill establishes a set of evidence-based rules based on nationally recognized protocol standards. In addition, the legislation ensures that the utilization review is done by a physician who is licensed to practice the procedure which has been requested to be performed, rather than an insurance administrator who lacks that medical expertise.