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 financed by fines collected by the Insurance Commissioner, aimed at educating healthcare providers and enhancing compliance assessments. The definition of "prior authorization" is updated to include various administrative functions required by utilization review entities, and additional disclosure requirements are imposed to ensure that healthcare providers and subscribers are informed about prior authorization requirements and clinical criteria. The bill also exempts certain healthcare services from prior authorization, clarifies the duration of approved authorizations, and sets forth a review process for non-compliance by utilization review entities.

Moreover, the bill introduces stringent compliance measures and penalties for healthcare insurers and utilization review entities. It requires healthcare providers to notify insurers or review entities of any non-compliance, mandating corrective action within one business day. The Insurance Commissioner is empowered to impose civil fines for violations, with escalating penalties for repeated offenses. The bill also ensures that authorized healthcare services are exempt from audit recoupment and mandates notification to both insurers and providers upon compliance findings. Complaints regarding violations can be filed with the department, and all collected fines will be directed to the State Treasury for the Prior Authorization Transparency Act Fund.

Statutes affected:
HB 1300: 23-99-1103(10), 23-99-1103(15), 23-99-1104, 23-99-1109(c), 23-99-1109, 23-99-1111(b)