This bill amends sections 9-5-32 and 33-25A-8s of the Code of West Virginia to modify the prior authorization process for healthcare services and medications. A key change is the exclusion of pharmaceutical medication from the prior authorization gold card process, which aims to streamline the approval process for prescribed medications. The bill also requires the Bureau of Medical Services and health maintenance organizations to implement user-friendly electronic portals for submitting prior authorization requests and mandates timely responses to these requests, including specific time frames for urgent cases. Additionally, it outlines the appeals process for denied prior authorizations. Moreover, the bill provides exemptions from prior authorization requirements for healthcare practitioners who consistently meet performance standards for a specified period. It emphasizes transparency by mandating the collection of data on prior authorization requests and denials, which will be monitored by the Inspector General and the Insurance Commissioner. The bill also grants the Insurance Commissioner the authority to impose civil penalties for violations of the new regulations, ensuring compliance and accountability in the prior authorization process. Overall, the bill seeks to enhance the efficiency of prior authorization while ensuring timely access to necessary medications and treatments for patients.

Statutes affected:
Introduced Version: 9-5-32, 33-25A-8s