RELATING TO PRIOR AUTHORIZATION.
Summary
Establishes a comprehensive regulatory framework for prior authorization process in the State, including disclosure and notice requirements for utilization review entities regarding their prior authorization requirements and restrictions; qualifications and criteria for prior authorization review and appeals personnel; prior authorization process for non-urgent and urgent health care services, including the time frame by which utilization review entities must render a decision; adverse determination and appeal processes; prohibition of prior authorization for emergency health care services and medication for opioid use disorder; payments to health care providers; length and duration of prior authorizations; and exemptions for certain health care providers. Requires health insurers to utilize NCPDP SCRIPT Standard electronic prior authorization transactions by 1/1/2026. Requires utilization review entities to submit annual reports to the Insurance Commissioner each year. Requires the Insurance Commissioner to submit annual reports to the Legislature. Requires the Insurance Commissioner to adopt rules by 1/1/2026.
Bill status
in committee
1 of 4 stages cleared
Introduction
Jan 2025
Committee Review
Floor Vote
Governor
Introduced Jan 22, 2025
Last action Jan 27, 2025
Floor votes
How they voted
No floor votes recorded yet.
Full legislative history
Actions timeline
Total actions
3
Key actions
0
Committee
1
Jan 27, 2025
Committee
Referred to CPN/HHS, WAM/JDC.
upper
Jan 23, 2025
Introduced
Introduced and passed First Reading.
upper
Jan 22, 2025
Introduced
Pending Introduction.
upper
2 primary · 0 co-sponsors
Sponsors
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