The New York Department of Health (DOH) adopted regulations effective on September 13, 2023, that revised Medicaid Utilization Review for Medicaid fee-for-service benefits. The regulations were ...

Concurrent review is a utilization review process that occurs while a patient is actively receiving treatment, such as during a hospital stay. It evaluates the medical necessity and appropriateness of ...

California is among a handful of states that seeks to regulate the use of artificial intelligence (“AI”) in connection with utilization review in the managed care space. SB 1120, sponsored by the ...

The powerful hospital lobby has been pushing a bill, A.3789 (Weprin)/S.7297 (Hoylman-Sigal), that would mandate arbitrary and impractical timelines on utilization review decisions – the process that ...

The State University of New York (SUNY) along with University at Buffalo School of Pharmacy and Pharmaceutical Sciences began a partnership with the New York State Department of Health (NYSDOH) Drug ...