The proposed bill would amend current statutes by introducing new requirements for health care insurers regarding the denial of claims and prior authorizations based on medical necessity. Specifically, it mandates that a medical director must individually review any denial of a claim or prior authorization that involves medical necessity before it can be issued. During this review, the medical director is required to exercise independent medical judgment and is prohibited from relying solely on recommendations from other sources. This change aims to ensure that decisions regarding medical necessity are made with thorough consideration and not based on external recommendations alone.

Additionally, the bill specifies that these provisions will take effect on July 1, 2026. The amendments will add new sections to Title 20 of the Arizona Revised Statutes, enhancing the oversight and accountability of medical directors in the claims and prior authorization processes. The current law remains unchanged except for the insertion of these new requirements, which are designed to improve the integrity of medical necessity determinations in health care insurance practices.

Statutes affected:
Introduced Version: 20-3103
House Engrossed Version: 20-3103
Senate Engrossed Version: 20-3103, 20-3407
Chaptered Version: 20-3103, 20-3407