Bill > SB0274

This bill amends Utah's health insurance preauthorization requirements to enhance transparency and protect patients' rights. The legislation modifies existing laws by requiring insurers to provide more detailed information about preauthorization processes, including mandating that insurers give specific, detailed explanations for any adverse preauthorization determinations (decisions to deny coverage). Insurers must now notify healthcare providers at least 30 days before changing authorization requirements and cannot revoke an authorization once granted, provided the healthcare provider follows the original authorization terms. The bill introduces new annual reporting requirements, compelling insurers to submit comprehensive data about preauthorization requests, including approval and denial rates, request submission methods, and appeal outcomes. Additionally, the bill specifies that appeals for clinical or medical necessity must be reviewed by licensed physicians or pharmacists, and insurers must ensure reviewers have appropriate medical knowledge about the patient's condition. The legislation also prohibits preauthorization requirements for emergency healthcare and provides patients with clearer information about appeal processes. The new reporting requirements will be in effect until July 1, 2029, and the bill is set to take effect on May 7, 2025.

Business and Industry, Health and Social Services

https://le.utah.gov/~2025/bills/static/SB0274.html