Bill > HB423

This bill creates a comprehensive framework for prior authorization in health insurance, requiring insurers to establish a program that allows healthcare providers to qualify for exemptions from prior authorization requirements. Under the proposed legislation, insurers must evaluate participating providers annually and grant prior authorization exemptions for specific health care services if the provider meets certain performance criteria, such as having a high approval rate for prior authorization requests and meeting utilization thresholds. The bill defines numerous terms, including expanded definitions of healthcare providers to include various mental health and counseling professionals, and outlines specific requirements for the exemption program, such as not conditioning exemptions on providers exceeding a 93% approval rate and providing notification to providers within 30 days of their annual evaluation. The legislation also mandates that the Commissioner of Insurance submit an annual report to the Legislative Research Commission detailing prior authorization statistics, including approval rates, denial rates, and processing times for both urgent and non-urgent healthcare services. Additionally, the bill prohibits insurers from conducting retrospective reviews solely based on a provider's prior authorization exemption and requires insurers to provide a process for providers to designate their preferred method of receiving forms and notices. The provisions will apply to health insurance contracts delivered, renewed, or amended on or after January 1, 2027, with some sections taking effect in 2026.