Bill > HB144

This bill establishes comprehensive regulations for prior authorization processes in health insurance, focusing on improving efficiency, transparency, and patient care. Starting January 1, 2027, health insurers must implement a streamlined prior authorization process with specific time requirements for responding to requests, such as providing decisions within designated hours for standard and expedited requests. The bill mandates that insurers make their prior authorization standards publicly available online, base these standards on evidence-based clinical review criteria, and provide clear explanations for any adverse determinations. Health care providers will have the right to request clinical peer reviews of prior authorization decisions, and insurers must maintain an application programming interface to automate prior authorization processes. The legislation also introduces important protections for patients, such as requiring exceptions to step therapy protocols for certain medical conditions like Stage 4 metastatic cancer and establishing a 12-month prior authorization validity period for chronic conditions. Additionally, the bill requires insurers to submit annual reports detailing their compliance with these new requirements and grants the insurance director the authority to monitor and enforce these regulations, with potential penalties for non-compliance. The goal is to reduce administrative burdens, improve communication between insurers, healthcare providers, and patients, and ensure more timely and patient-centered medical care.

Business and Industry, Health and Social Services

https://www.akleg.gov/basis/Bill/Detail/34?Root=HB144