NYSDOH COVID-19 Guidance on Suspension of Health Plan Utilization Review Requirements

Jackie Pappalardi and Lisa Volk

The New York State Department of Health (NYSDOH) is providing the attached Guidance to address health care provider responsibilities in accordance with the health insurance industry’s suspension of certain utilization review requirements pursuant to the Department of Financial Services Circular Letter No. 8 (2020), and other voluntary reductions and eliminations in authorization requirements. Utilization review is used to determine if a requested health care service is medically necessary. This guidance is provided due to the state disaster emergency declared by Executive Order No. 202 and shall remain in effect until subsequent notice from NYSDOH, which will be provided prior to, or upon, the expiration of such state disaster emergency.