House Bill No. 1811 amends existing insurance law regarding the treatment of chronic conditions and the validity period for prior authorizations for both inpatient and non-inpatient care. The bill stipulates that prior authorizations for non-inpatient care must remain valid for at least six months, while those for inpatient acute care must be valid for at least fourteen calendar days. Additionally, if an enrollee requires continued inpatient care beyond the initially approved length of stay, the utilization review entity must evaluate the request using the same criteria as the initial authorization. The bill also modifies the timeframe for timely requests for continuation of inpatient care from seventy-two hours to twenty-four hours prior to the termination of the previous authorization.

Furthermore, if a utilization review entity does not respond to a timely request for continuation of inpatient care before the previous authorization expires, the health benefit plan is required to continue compensating the healthcare provider at the contracted rate until a determination is made. The bill clarifies that it does not mandate coverage for services that are completely excluded from the policy's benefits, regardless of medical necessity. This act is set to take effect on November 1, 2025.