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, which will be utilized for educating healthcare providers and enhancing compliance assessments. The definition of "prior authorization" is clarified to indicate that it is a requirement mandated by a utilization review entity, and new disclosure requirements are imposed on these entities. They must provide detailed information about prior authorization requirements, clinical criteria, and restrictions on their websites, and notify healthcare providers of any changes at least 60 days in advance. The bill also exempts certain healthcare services from prior authorization and clarifies the duration of approved requests, ensuring that insurers pay claims for services that received prior authorization unless specific conditions are met.

Additionally, the bill introduces a review entity responsible for issuing authorizations and managing compliance processes. If a healthcare insurer or utilization review entity fails to comply with regulations, the Insurance Commissioner can mandate the issuance of necessary authorizations and impose monetary penalties. Authorized healthcare services are protected from audit recoupment, and healthcare providers can report compliance failures to insurers, who must take corrective actions. The bill also establishes civil fines for noncompliance, which can accumulate daily, with collected fines deposited into the Prior Authorization Transparency Act Fund. Overall, the legislation aims to streamline the prior authorization process, reduce delays in care, and ensure that both healthcare providers and patients have access to clear information regarding authorization requirements.

Statutes affected:
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)
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)
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)