S 4833 New York Senate · 2025 Regular Session

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

Summary
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.
Bill status in committee 1 of 4 stages cleared
Introduction
Feb 2025
Committee Review
Floor Vote
Governor
Introduced Feb 13, 2025 Last action Jan 7, 2026
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Full legislative history

Actions timeline

Total actions
2
Key actions
0
Committee
2
Jan 7, 2026
Committee
REFERRED TO INSURANCE
upper
Feb 13, 2025
Committee
REFERRED TO INSURANCE
upper
1 primary · 1 co-sponsor

Sponsors