Committee passes bill tightening utilization-review requirements and ZIP-code reporting for denials
The subcommittee unanimously passed Senate Bill 474, adopting amendments that require denial and grievance notices to include prominent information, mandate dedicated contact channels for private review agents, require posting of utilization-review criteria, and add ZIP-code reporting to analyze regional denial patterns.
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Madam Chair introduced Senate Bill 474 and asked Lisa, a committee staff member, to summarize the Senate amendments. Lisa said the amendments require that denial and grievance notices include specified information prominently, require private review agents to provide a dedicated phone number and email for utilization-review inquiries (to be answered within two business days unless a shorter timeframe applies), require specified utilization-review criteria to be posted on member and provider pages of private-review-agent websites, and add ZIP-code-based reporting of specified data.
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