AN ACT CONCERNING COVERAGE FOR MEDICALLY NECESSARY TREATMENT IN THIS STATE.
To: (1) Require any health carrier to align coverage guidelines with the most recent evidence-based medical standards; (2) require transparency in health carriers' claim-review practices; (3) require coverage for medical treatments for life-saving care that are recommended by licensed health care provider specialists, unless medical evidence justifies denial of such coverage; (4) revise the process for review of adverse determinations to require (A) review of nonurgent care requests to be resolved within ten business days, and (B) review of urgent care requests to be resolved within forty-eight hours.
Introduced by:
Rep. Raghib Allie-Brennan, 2nd Dist.
