Bill > H1136

This bill aims to improve the health insurance prior authorization process by introducing several key provisions. It requires health insurance carriers to maintain a publicly accessible, searchable list of all items, services, and medications that require prior authorization, ensuring transparency and preventing surprise requirements. The bill mandates that carriers and utilization review organizations report detailed annual data about prior authorization requests, including approval and denial rates, processing times, and appeal outcomes. It also introduces protections for patients, such as preventing retrospective denials of already-approved services, ensuring continuation of previously approved treatments for at least 90 days when a patient changes insurance, and mandating that preauthorization approvals remain valid for at least one year. The bill further regulates the use of artificial intelligence in prior authorization decisions, requiring that such tools do not discriminate, do not replace healthcare provider decision-making, and are subject to periodic review. Additionally, the bill establishes a task force to study the impact of prior authorization on healthcare costs and access, with the goal of developing recommendations to simplify and standardize the process across insurance carriers. The legislation aims to reduce administrative burdens on healthcare providers, improve patient access to necessary care, and increase transparency in the prior authorization process.