The Coalition testified in support of SB 342, which would have required clinical peer review of insurance denials so that a qualified clinician, not an automated system, makes the call. It passed the Senate 34-1 on May 5 and was placed on the House calendar, but the session ended before the House voted.
Part of the idea moved forward anyway. In September, Comptroller Sean Scanlon announced that starting January 1 every denial of care in the State Employee Health Plan and the Partnership Plan, which together cover more than 270,000 people, must get a human review. Carriers also can’t rely on AI alone to downcode claims or cut provider payments, and they have to tell members when AI played a meaningful part in a decision about their care.