Senate Bill No. introduced by V. Ricci and others aims to revise laws related to health utilization review by establishing specific qualifications for physicians involved in making adverse determinations and reviewing grievances for utilization review organizations. The bill stipulates that only licensed physicians can perform these tasks, ensuring they possess a current, valid nonrestricted medical license and have relevant specialties and experience related to the medical conditions under review. Additionally, the bill mandates that these physicians operate under the clinical direction of a medical director who is also a licensed physician in the state.

Furthermore, the bill introduces a provision for automatic approval of health care services if a health insurance issuer or utilization review organization fails to comply with specified requirements. This means that if the organization does not adhere to the established laws regarding adverse determinations and grievance reviews, the health care service in question will be automatically deemed authorized. The bill includes several new sections that outline these requirements and is intended to be codified within existing legal frameworks.