The bill amends the Prior Authorization Transparency Act to improve transparency and accountability in the prior authorization process for healthcare services. It establishes the "Prior Authorization Transparency Act Trust Fund" to support education for healthcare providers and enhance compliance assessments. The definition of "prior authorization" is clarified to indicate it is a requirement set by a utilization review entity, detailing the conditions under which it is necessary. Furthermore, utilization review entities are mandated to clearly disclose their prior authorization requirements and clinical criteria on their websites, as well as provide detailed statistics on approvals and denials. Insurers are also required to pay claims for services that received prior authorization, regardless of terminology, and new conditions are introduced for claims to be paid without prior authorization.

The bill also outlines new procedures for authorization and compliance, requiring review entities to either issue authorizations, resend unanswered requests, or refer unresolved issues to the State Insurance Department. The Insurance Commissioner is empowered to enforce compliance, including ordering authorizations and imposing monetary penalties for violations. Healthcare providers can notify insurers of compliance failures, prompting corrective actions within one business day, and civil fines for repeated non-compliance can reach up to $100,000. The legislation aims to streamline the prior authorization process, reduce delays in care, and ensure that healthcare providers and patients have access to necessary information regarding authorization requirements.

Statutes affected:
Old version HB1300 Original - 1-29-2025 01:46 PM: 23-99-1103(10), 23-99-1103(15), 23-99-1104, 23-99-1109(c), 23-99-1109, 23-99-1111(b)
Old version HB1300 V2 - 2-20-2025 11:46 AM: 23-99-1103(10), 23-99-1103(15), 02-20-2025, 23-99-1104, 23-99-1109(c), 23-99-1109, 23-99-1111(b)
Old version HB1300 V3 - 3-3-2025 10:12 AM: 23-99-1103(10), 23-99-1103(15), 03-03-2025, 23-99-1104, 23-99-1109(c), 23-99-1109, 23-99-1111(b)
Old version HB1300 V4 - 3-13-2025 10:16 AM: 23-99-1103(10), 23-99-1103(15), 03-13-2025, 23-99-1104, 23-99-1109(c), 23-99-1109, 23-99-1111(b)
HB 1300: 23-99-1103(10), 23-99-1103(15), 23-99-1104, 23-99-1109(c), 23-99-1109, 23-99-1111(b)
Act 510: 23-99-1103(10), 23-99-1103(15), 03-13-2025, 23-99-1104, 23-99-1109(c), 23-99-1109, 23-99-1111(b)