The bill, HB1271, amends the Prior Authorization Transparency Act by exempting certain healthcare providers from prior authorization requirements for specific services, particularly if they have received approval for 90% or more of their prior authorization requests during a specified period. It introduces new definitions such as "random sample" and "value-based reimbursement," and clarifies the roles of healthcare insurers and utilization review entities. The bill mandates that utilization review entities disclose their prior authorization requirements on their websites and establishes a process for healthcare providers to discuss adverse determinations with licensed physicians. It also outlines conditions for granting, evaluating, and potentially rescinding exemptions, promoting transparency and communication between providers and insurers.

Additionally, the bill stipulates that insurers can only rescind prior authorization exemptions if less than 90% of claims meet medical necessity criteria, requiring at least 25 days' notice to providers before rescission. It allows providers to appeal adverse determinations and mandates that insurers cover the costs of these appeals. The bill also establishes a process for independent reviews of exemption determinations and ensures that insurers cannot retroactively deny payment for services covered under an exemption unless specific conditions are met. Furthermore, it outlines a framework for reviewing prior authorizations for prescription drugs, requiring submissions to the Arkansas State Board of Pharmacy, which will set criteria and handle appeals. Overall, HB1271 aims to enhance transparency and reduce administrative burdens in the prior authorization process for healthcare providers and patients.

Statutes affected:
Old version HB1271 V2 - 3-6-2023 09:40 AM: 23-99-1103(8), 23-99-1103, 23-99-1104(a), 23-99-1111, 03-06-2023
Old version HB1271 V3 - 3-9-2023 09:47 AM: 23-99-1103(8), 23-99-1103, 23-99-1104(a), 23-99-1111, 03-09-2023
Old version HB1271 V4 - 3-16-2023 03:14 PM: 23-99-1103(8), 23-99-1103, 23-99-1104(a), 23-99-1111, 03-16-2023
HB 1271: 23-99-1103(8), 23-99-1103, 23-99-1104(a), 23-99-1111, 03-16-2023
Act 575: 23-99-1103(8), 23-99-1103, 23-99-1104(a), 23-99-1111, 03-16-2023