This bill, raised by the General Assembly, aims to establish electronic notifications for prior authorizations in the healthcare industry. It proposes amending Section 38a-591c of the general statutes by adding subsections (e) and (f).

Under subsection (e), the commissioner is required to develop technical standards for hospitals and healthcare professionals to electronically file prior authorization requests and other requests for utilization reviews with health carriers. The commissioner is also tasked with developing standardized clinical review criteria for common services provided in hospitals. These technical standards and criteria will be developed in consultation with standard-setting organizations, hospitals, healthcare professionals, health carriers, and health information technology software vendors.

Subsection (f) requires each health carrier to establish an electronic program by March 1, 2024, that allows for the secure electronic filing of prior authorization requests and the submission of clinical information by hospitals and healthcare professionals. The program must also transmit the health carrier's responses to these requests. The electronic program must comply with the technical standards developed by the commissioner. Additionally, health carriers must provide hospitals and healthcare professionals with access to their criteria for making determinations on prior authorization requests and other utilization reviews. Health carriers are also required to consult with hospitals to ensure seamless transmission and processing of these requests.

Statutes affected:
Raised Bill:
INS Joint Favorable:
File No. 317:
APP Joint Favorable: