The bill seeks to improve the health insurance prior authorization process by requiring all licensed carriers to maintain a publicly accessible list of items, services, and medications that require prior authorization. It mandates annual reporting of prior authorization data, including approval and denial rates, to the division of insurance. Carriers must also update their websites and notify affected individuals when implementing or amending prior authorization requirements. Additionally, the bill prohibits retrospective denial of authorization for services already approved unless based on fraudulent information, thereby enhancing transparency and protecting patient access to healthcare.

Furthermore, the bill introduces guidelines for utilization review criteria, emphasizing evidence-based practices developed with physician input. It requires that prior authorization requests be processed through an automated application programming interface and addresses the use of artificial intelligence in the review process, ensuring that decisions are made by licensed healthcare providers rather than solely relying on AI. The bill also establishes a task force to study the impact of prior authorization on healthcare costs and access, with the goal of simplifying and standardizing these processes. Amendments to existing laws will align prior authorization forms with national standards, impose penalties for non-compliance, and require the division of insurance to develop uniform rules based on the task force's recommendations. The implementation of these changes will occur in phases, with some provisions taking effect immediately and others scheduled for future dates.

Statutes affected:
Bill Text: 175-24B