Bill > HB1045

This bill creates new provisions in Missouri law relating to prior authorization of health care services. It prohibits health carriers or utilization review entities from requiring prior authorization for a health care service unless the provider has received prior authorization approvals for less than 90% of requests in the most recent evaluation period. The bill also requires health carriers and utilization review entities to notify providers of prior authorization determinations, maintain an online portal for providers to access prior authorization data, and limits their ability to deny or reduce payment for services with prior authorization. The provisions do not apply to MO HealthNet or providers who have not participated in the health plan for at least one full evaluation period.