This bill proposes several updates to the Arizona Revised Statutes regarding health insurance, specifically focusing on the processes surrounding prior authorizations and utilization reviews. Key changes include the introduction of new definitions, such as "enrollee," and modifications to existing terms, such as "final internal adverse determination," which now includes cases where internal review processes have been waived or deemed exhausted. The bill also clarifies the definition of "health care setting" and expands the responsibilities of health care insurers and utilization review agents in terms of prior authorization requirements, including the obligation to honor prior authorizations granted by previous insurers for a specified period.

Additionally, the bill establishes new provisions that exempt providers from prior authorization requests for certain services after meeting specific criteria, such as a high approval rate of prior requests. It mandates that health care insurers provide clear communication regarding prior authorization requirements and adverse determinations, including timelines for notifications and opportunities for providers to discuss medical necessity. The bill also emphasizes the need for transparency in the prior authorization process, requiring insurers to disclose statistical information about requests and determinations to the public. Overall, these updates aim to streamline the authorization process, enhance provider autonomy, and improve patient access to necessary health care services.

Statutes affected:
Introduced Version: 20-2501, 20-2512, 20-2513, 20-2514, 20-2531, 20-3403, 20-3404, 20-3405, 20-3401, 20-2534, 20-2535, 20-2536, 20-2530, 20-2505, 20-1691, 20-3406