Bill > H1200

This bill aims to improve the health insurance prior authorization process. It requires health insurance plans, including student health insurance plans, to adopt utilization review criteria that are scientifically derived and evidence-based, and to make these criteria easily accessible to the public. The bill also prohibits plans from retrospectively denying authorization for services that were previously approved, unless the approval was based on inaccurate information or the services were not provided as authorized. Additionally, the bill establishes a committee within the Division of Insurance to develop recommendations for simplifying prior authorization standards and processes, including identifying services that have low prior authorization denial rates and eliminating prior authorization requirements for those services. The committee is also tasked with developing recommendations for standardizing prior authorization processes, forms, and requirements across carriers. The Health Policy Commission is required to analyze the progress of adopting statewide forms and electronic prior authorization standards, and to provide a report with findings and recommendations to the committee established under the bill.

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https://malegislature.gov/Bills/192/H1200