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Committee passes bill tightening utilization-review requirements and ZIP-code reporting for denials
Summary
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.
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.
Lisa explained an effective-date change was added so private review-agent processes would be implemented promptly and would not delay utilization-review operations. Madam Chair noted that the emergency-response provision in current law (which requires a response within 24 hours for emergency situations) should not be conflicted by the bill’s timelines.
The committee adopted the Senate amendments on a motion and passed SB 474 unanimously with no recorded opposition. Madam Chair described the measure as "a really important bill for this session" and said the edits fine-tuned the bill to ensure timely implementation.
Next steps: SB 474 moves forward after subcommittee passage; the transcript records unanimous approval in the remote session but does not include a roll-call tally.
