Summary
Overhauls prior authorization in health insurance: sets standards and timelines, requires reporting to the Insurance Commissioner, and strengthens appeals. If deadlines are missed, requests can be deemed authorized; directs studies on secure electronic submission via health records.
Healthcare Implications
Bars automated systems from issuing adverse determinations without a licensed physician; strengthens human oversight and patient protections. Payers may still use AI for intake/screening, but workflows must ensure clinical judgment, auditability, and timely responses. Electronic prior auth pushes Electronic Health Record integration and may reshape how AI prepares medical‑necessity evidence.