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 that it is a requirement mandated by a utilization review entity, which must be completed by a healthcare provider or subscriber before a coverage determination. Additionally, utilization review entities are required to disclose their prior authorization requirements and clinical criteria clearly on their websites, and they must provide detailed statistics on prior authorization approvals and denials.

Further provisions include a mandate for utilization review entities to notify healthcare providers of any changes to prior authorization requirements at least 60 days in advance. The bill also ensures that healthcare insurers must pay claims for services that received prior authorization, regardless of terminology, and introduces conditions under which claims may be paid without prior authorization. It outlines a process for compliance failures, allowing healthcare providers to notify insurers, who must then take corrective actions within one business day. Civil fines for ongoing non-compliance can reach up to $100,000 for repeated violations, with collected fines deposited into the Trust Fund. Overall, the bill aims to streamline the prior authorization process and reduce barriers to care while ensuring access to necessary information for healthcare providers and patients.

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)