Relating to health benefit plan preauthorization requirements for participating physicians and providers providing certain health care services.
What changed between versions
Added seven specific categories of health care services that cannot require preauthorization, including emergency care, intervention-necessary care, outpatient mental health/substance use treatment, and preventive services.
Modified the prohibited services list to include fully capitated risk-sharing arrangements and intravitreal prescription drugs provided by ophthalmologists.
Added new provisions prohibiting denial or reduction of payment for services not requiring preauthorization, except in cases of fraud or failure to substantially perform the service.
Added requirements for insurers to provide written notice when they incorrectly require preauthorization for protected services.
Redefinition of 'intervention-necessary care' to clarify it includes services that would lead to serious deterioration if not treated within a reasonable time.
Removed the detailed definition of 'chronic health condition' which was present in the original version.
Added specific effective date of September 1, 2025, and applicability date of January 1, 2026.
