Relating to health benefit plan preauthorization requirements for certain health care services and the direction of utilization review by physicians.
What changed between versions
Changed evaluation period for preauthorization exemptions from six months to one year, affecting when exemptions can be rescinded and how often reviews occur.
Added requirement that preauthorization exemption reviews must include all submitted requests regardless of which insurance policy they were made under.
Added requirement that when fewer than five claims exist for evaluation, all claims must be reviewed rather than using a random sample.
Modified appeal process to allow physicians to request independent review without first completing internal appeals, and clarified that reviewing physicians cannot hold administrative medicine licenses.
Added new reporting requirements mandating annual reports on exemptions granted, rescinded, or denied, including independent review outcomes.
Extended the waiting period before preauthorization exemptions can be rescinded from one year to one year after the evaluation period that formed the basis of denial.
