The bill amends the Prior Authorization Transparency Act in Arkansas, focusing on the exemption process for healthcare providers from prior authorization requirements. It removes the previous condition that a provider must have received approval for 90% or more of their prior authorization requests to qualify for an exemption. Instead, a streamlined evaluation process is established, allowing healthcare insurers to grant or deny exemptions based on a retrospective review of claims. Additionally, the bill requires insurers to provide at least 60 days' notice before rescinding an exemption and clarifies the criteria for maintaining these exemptions. It also mandates that exemptions be extended to groups of providers sharing the same tax identification number, with protections against payment denials for exempted services unless there is clear evidence of misrepresentation.

Moreover, the bill introduces amendments regarding healthcare provider notifications and prior authorization processes for prescription drugs. It requires that upon submitting a program, the submitting entity must notify each healthcare provider with details about the submission, including a deadline for comments, which is set at a minimum of thirty days. The previous deadline of January 1, 2025, for program submission and approval by the Legislative Council is removed, allowing for compliance without a specified date. The bill also clarifies that healthcare insurers or pharmacy benefits managers must submit written requests for prior authorization review to the Arkansas State Board of Pharmacy, detailing the reasons for each request, and ensures that any determinations affecting a provider's exemption status are communicated to them. Overall, these amendments aim to improve transparency and communication between healthcare providers and insurers.

Statutes affected:
HB 1301: 23-99-1120, 23-99-1122(c), 23-99-1125, 23-99-1121(a), 23-99-1122(a), 23-99-1126(a), 23-99-1126(d), 23-99-1127, 20-77-2701, 23-99-1126, 23-61-801, 23-61-1001, 23-99-1128, 25-20-104, 23-99-1128(a)