Bill > HB2250

This bill aims to streamline and improve the prior authorization process for health insurance in Arizona, particularly for habilitative services. It introduces provisions that require health insurers to honor prior authorizations granted by previous insurers for at least 90 days when a patient switches plans, provided the service is covered and documentation is provided, and allows insurers to conduct their own review during this period. The bill also states that changes in coverage or approval criteria cannot affect an enrollee if they received a prior authorization within the year before the change, and enrollees won't have to repeat step therapy protocols if they previously discontinued a drug due to ineffectiveness or adverse events. For rehabilitative and habilitative services like physical and occupational therapy, insurers generally cannot require prior authorization for the first twelve visits per new episode of care, defined as treatment for a new condition or a recurring condition not treated in the last 90 days, though insurers can still deny claims if services are not medically necessary. Additionally, providers who have had at least 90% of their prior authorization requests for a specific service approved by an insurer in the past year, and have submitted at least five requests for that service, will be exempt from prior authorization for that service for 12 months, with provisions for evaluating and revoking these exemptions. The bill also mandates that insurers make their prior authorization requirements and restrictions detailed and easily understandable on publicly accessible websites, provide advance notice of changes, and ensure that adverse determinations are made by qualified physicians. Timelines for prior authorization decisions are shortened, with urgent requests needing a response within three calendar days and non-urgent requests within five calendar days, and requests are considered granted if these deadlines are missed, unless there's fraud or misrepresentation. Finally, for prescription drugs for chronic pain, prior authorizations will be honored for six months, with specific exceptions for certain medications and conditions.

Health and Social Services

https://apps.azleg.gov/BillStatus/BillOverview/83971