The bill amends the Wyoming insurance code to require that all prior authorization adverse determinations and appeals be made and reviewed by health care providers who are licensed in Wyoming. Specifically, it mandates that health insurers or contracted utilization review entities ensure that these determinations and reviews are conducted by physicians or other appropriate licensed health care providers who hold a current and unrestricted license to practice within the scope of their profession in Wyoming.

The bill also specifies that the changes will apply to prior authorization adverse determinations made or appealed on or after July 1, 2025, with the effective date of the act set for the same day. Notably, the bill removes references to other states, territories, and the District of Columbia, emphasizing the requirement for Wyoming licensure.

Statutes affected:
Introduced: 26-55-104, 26-55-106