The bill amends the Prior Authorization Transparency Act to improve the clarity and transparency of prior authorization processes in healthcare. 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 updated to clarify that it is a requirement mandated by a utilization review entity, encompassing various types of reviews and notifications. The bill also mandates that utilization review entities clearly disclose their prior authorization requirements and clinical criteria on their websites. Furthermore, it exempts certain healthcare services from prior authorization, clarifies the duration of approved requests, and outlines a review process for non-compliance with the Act.

Additionally, the bill introduces new provisions regarding authorization and compliance processes, requiring review entities to either issue authorizations, resend unanswered requests, or refer unresolved matters to the State Insurance Department. The Insurance Commissioner is empowered to order compliance and impose monetary penalties for violations. Authorized healthcare services are exempt from audit recoupment, and healthcare providers can notify insurers of compliance failures, prompting corrective actions. The bill also includes provisions for civil fines for noncompliance, which can accumulate daily, with collected fines directed to the Prior Authorization Transparency Act Fund. Overall, the bill aims to enhance transparency, accountability, and timely access to necessary healthcare services.

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)