Relates to downcoding on initial review and audits reversing or altering medical necessity determinations

Introduced

In Committee

Floor

Crossed Over

Passed

Enacted

Overview Bill text 1 History 2 Sponsors

Ensures the decision to downcode an insurance claim is recognized as an adverse determination; prohibits health plans from reversing or altering medical necessity determinations made by a utilization review agent or external appeals agent as a result of an audit of claims.

Chamber: House
Introduced: Jan 30, 2025
Last action: Jan 7, 2026 — REFERRED TO INSURANCE
Session: 2025-2026
Momentum: 33 · Low

PASSAGE PROBABILITY

1% Unlikely

Why this number

Stage base In Committee — base rate 5%, measured from NY's completed sessions
Momentum -4 33/100 from the pace of recorded action
Time since last action -22 289 days quiet

A transparent scoring model over stage, momentum, recency, sponsorship and recorded votes — not a trained predictor. Treat it as a way to rank attention, not as a forecast.