INSURANCE PRIOR AUTHORIZATION EXEMPTIONS

HB 302 creates a new process for health care professionals (like doctors and specialists) to qualify for exemptions from their health insurer’s prior authorization requirements for outpatient services. To qualify, a professional must have had at least 90% of their prior authorization requests approved in the previous six-month period for the same service type. Insurers must grant exemptions within 10 business days if criteria are met, provide clear written explanations for denials, and allow independent reviews of rescission decisions within 30 days. The exemption does not cover pharmaceutical services or prescription drugs.