The bill amends the "Benefit Determination and Utilization Review Act" to streamline the prior authorization process for healthcare services. It prohibits insurers from imposing prior authorization requirements for any admission, item, service, treatment, test, exam, study, procedure, or any generic or brand name prescription drug ordered by a primary care provider, with exceptions for controlled substances and for individual primary care providers with documented cases of fraud, waste, or abuse.

Starting January 1, 2026, insurers must use a single, standardized prior authorization form that does not exceed two pages in length, excluding instructions. The form must be made available electronically, and providers may submit the completed form electronically to the health benefit plan. Insurers are required to create online portals for the submission of the standardized form, which must be accessible to providers by January 1, 2026. Additionally, insurers must submit their prior authorization forms to the Office of the Health Insurance Commissioner to be kept on file, and any subsequent modifications must also be filed. The Office of the Health Insurance Commissioner may promulgate rules and regulations to further standardize and reduce the burden of prior authorization on providers.

The bill also updates the duties of the secretary of the Office of Health and Human Services to ensure that insurers minimize administrative burdens that may delay medically necessary care, including the prohibition of prior authorization requirements for services ordered by in-network primary care providers, with the same exceptions for controlled substances.

Furthermore, the bill includes provisions for the Office of the Health Insurance Commissioner to conduct analyses on various healthcare services, including anti-cancer medication coverage and mental health parity compliance, with findings reported to the General Assembly and the Governor. The bill aims to enhance healthcare efficiency, minimize administrative burdens on providers, and ensure transparency and stakeholder engagement in the healthcare system.

Statutes affected:
6317: 27-18.9-2, 42-7.2-5, 42-14.5-3