SF 122

 2026  26LSO-0506
                               STATE OF WYOMING
                              SENATE FILE NO. SF0122
 Medical necessity standard-timeline amendments.
 Sponsored        by:     Senator(s)  Dockstader and  Brennan      and
                        Representative(s) Erickson
                                      A BILL
                                           for
1 AN ACT relating to the insurance code; amending the number
2 of   days    a   health       insurer     has   to   determine     the   medical
3 necessity of a health care service; amending the number of
4 days    an   independent  review    organization      has    to   make    an
5 external review determination regarding medical necessity
6 of a health care service; and providing for an effective
7 date.
8
9 Be It Enacted by the Legislature of the State of Wyoming:
10
11Section  1.    W.S.   26-40-201(d)       and    (m)(intro)  is
12 amended to read:
13
1426-40-201.  Payment of claims under medical necessity
15 standard; review.
                                            1  SF0122
 2026  STATE OF WYOMING  26LSO-0506
1
2(d)   A claimant shall have not less than thirty (30)
3 days in which to file a request for the review provided in
4 subsection (c) of this section and such review shall be
5 completed by the insurer, and a decision delivered to the
6 claimant, no not later than forty-five (45) twenty-one (21)
7 days after receipt of a request for review.
8
9(m)   Within forty-five (45) Not later than twenty-one
10 (21) days after the date of receipt of the request for
11 external      review,     the      assigned        independent    review
12 organization shall provide written notice to the claimant,
13 the insurer and the commissioner of its decision to uphold
14 or reverse the decision of the insurer that the provision
15 of or payment for medical services, procedures or supplies
16 requested    by   the   claimant       are   not   medically   necessary.
17 Such written notice shall include:
18
19Section 2.   This act is effective July 1, 2026.
20
21(END)
                                    2  SF0122