Summary
Comprehensive prior-authorization reform: adverse prior authorization determinations must be made by a physician (or clinical peer for non-physician requests), appeals reviewed by a same/similar-specialty physician, uniform PA forms, and firm timelines. Functionally prevents automated/AI-only denials.
Healthcare Implications
Requires human clinical accountability in utilization management decisions and speeds determinations, reshaping payer/UM vendor automation; providers gain clearer escalation paths and deemed-approved protections if timelines are missed.