Health Insurance Preauthorization Amendments
What changed between versions
Insurers must now disclose on their websites and to providers/enrollees whether they use artificial intelligence to review authorization requests.
Authorizations for drugs or services treating chronic or long-term conditions must now be valid for a minimum of 12 months.
Insurers must provide a detailed notice explaining the reasons for an adverse preauthorization determination, including specific approved and denied billing codes.
Insurers must report specific statistics to the Insurance Department, including the number of appeals and outcomes, with a special exemption for prescription drug data.
The deadline for making a standard preauthorization decision was shortened to seven calendar days, and urgent care decisions must be made within 72 hours.
Individuals reviewing adverse preauthorization determinations are now required to use independent medical judgment and cannot rely solely on recommendations from other sources.
Definitions were updated to clarify terms like 'chronic or long-term care condition' (lasting at least three months) and 'generative artificial intelligence'.
