Senate Bill 561-FN proposes significant changes to the prior authorization process for health care services. The bill revises the definition of "clinical review criteria" and introduces new definitions for "prior authorization" and "prior authorization determination," specifying the approval process required for coverage of health care services, items, or prescription drugs. It also defines "urgent care" and expands the definitions of "utilization review" and "utilization review entity." The bill requires health carriers to disclose prior authorization requirements on their websites and mandates annual filing of written procedures for utilization review with the commissioner. Additionally, it sets deadlines for health carriers to respond to prior authorization requests and stipulates that approvals cannot be revoked within 60 business days of the approval date. The bill does not mention specific insertions or deletions of legal language.

Furthermore, SB 561-FN outlines the conditions under which payment to health care providers is guaranteed following prior authorization and introduces the option for providers to request a peer-to-peer review of prior authorization requests. It also revises the licensure requirements for medical utilization review entities, requiring them to employ licensed medical directors or dentists. New sections are added to RSA 420-E, establishing standards and timelines for processing prior authorization requests. The bill clarifies the circumstances under which a prior authorization request is considered approved and the duration of such approvals. It ensures that the requirements apply to all medical services and items and preserves the right to external review. The act is set to take effect on January 1, 2025.

Statutes affected:
Introduced: 420-J:3, 420-E:1, 420-E:2-a
As Amended by the Senate: 420-J:3, 420-J:5, 420-E:1, 420-E:2-a
Version adopted by both bodies: 420-J:3, 420-J:5, 420-E:1, 420-E:2-a
CHAPTERED FINAL VERSION: 420-J:3, 420-J:5, 420-E:1, 420-E:2-a