SF0122 • 2026

Medical necessity standard-timeline amendments.

AN ACT relating to the insurance code; amending the number of days a health insurer has to determine the medical necessity of a health care service; amending the number of days an independent review organization has to make an external review determination regarding medical necessity of a health care service; and providing for an effective date.

Inactive

Wyoming marks this bill as inactive, which usually means it is no longer moving in the current session.

Sponsor: Senator Dockstader
Last action: 2026-03-03
Official status: inactive
Effective date: 3/1/2026

Plain English Breakdown

The bill does not specify the reasons why the time limits were changed.

Medical Necessity Standard-Timeline Amendments

The bill changes the time limits for health insurers and independent review organizations to make decisions about medical necessity claims.

What This Bill Does

Changes the number of days a health insurer has to decide on a medical necessity claim from 45 to 21 days.
Changes the number of days an independent review organization has to make a decision on external reviews from 45 to 21 days.

Who It Names or Affects

Health insurers
Independent review organizations
Claimants (people filing medical necessity claims)

Terms To Know

claimant: The person who is seeking payment for a medical service, procedure, or supply.

Limits and Unknowns

It is unclear how these changes will impact the overall process of resolving medical necessity claims.
There are no details on what happens if a decision is not made within the new time frames.

Bill History

2026-03-03 House
H:Died in Committee Returned Bill Pursuant to HR 5-4
2026-03-03 House
H No report prior to CoW Cutoff
2026-02-23 House
H Introduced and Referred to H10 - Labor
2026-02-20 House
H Received for Introduction
2026-02-20 Senate
S 3rd Reading:Passed 29-2-0-0-0
2026-02-19 Senate
S 2nd Reading:Passed
2026-02-18 Senate
S COW:Passed
2026-02-16 Senate
S Placed on General File
2026-02-16 Senate
S10 - Labor:Recommend Do Pass 5-0-0-0-0
2026-02-13 Senate
S Introduced and Referred to S10 - Labor 30-1-0-0-0
2026-02-11 Senate
S Received for Introduction
2026-02-11 LSO
Bill Number Assigned

Current Bill Text

Read the full stored bill text

26LSO-0506
2026
STATE OF WYOMING
26LSO-0506
Numbered
2.0

SENATE FILE NO. SF0122

Medical necessity standard-timeline amendments.

Sponsored by: Senator(s) Dockstader and Brennan and Representative(s) Erickson

A BILL

for

AN ACT relating to the insurance code; amending the number of days a health insurer has to determine the medical necessity of a health care service; amending the number of days an independent review organization has to make an external review determination regarding medical necessity of a health care service; and providing for an effective date.

Be It Enacted by the Legislature of the State of Wyoming:

Section 1
.

W.S. 26
‑
40
‑
201(d) and (m)(intro) is amended to read:

26
‑
40
‑
201.

Payment of claims under medical necessity standard; review.

(d)

A claimant shall have not less than thirty (30) days in which to file a request for the review provided in subsection (c) of this section and such review shall be completed by the insurer, and a decision delivered to the claimant,
no
not
later than
forty
‑
five (45)
twenty
‑
one (21)
days after receipt of a request for review.

(m)

Within forty
‑
five (45)
Not later than twenty
‑
one (21)
days after the date of receipt of the request for external review, the assigned independent review organization shall provide written notice to the claimant, the insurer and the commissioner of its decision to uphold or reverse the decision of the insurer that the provision of or payment for medical services, procedures or supplies requested by the claimant are not medically necessary.

Such written notice shall include:

Section 2
.

This act is effective July 1, 2026
.

(END)

1
SF0122