A bill for an act relating to health carriers standards of conduct; utilization review organizations, artificial intelligence, audits, and prior authorizations; certificate of need processes; and including applicability provisions.

Added a specific definition for 'downgrade' to clarify when a utilization review organization changes an expedited or urgent request to a standard one.

Modified the rules on artificial intelligence to allow its use for initial reviews but explicitly prohibit using AI as the sole reason to deny, delay, or downgrade a request for medically necessary care.

Added new requirements for audits, including a 15-day notice period before starting an audit and a 45-day limit to complete it and issue a determination.

Added new requirements for prior authorization denials, mandating that they be made by qualified physicians or clinical peers who provide written explanations and attestations of their expertise.

Added a requirement that all prior authorization requests be submitted electronically via standards-based interfaces starting July 1, 2027.

Added enforcement provisions that require claims to be approved and paid with 10% annual interest if a utilization review organization violates the new audit rules.