Bill > SB330

This bill, known as the Ensuring Transparency in Prior Authorization Act, aims to regulate the use of prior authorization, which is a process where an insurance company or health maintenance organization determines if a proposed healthcare service is medically necessary and appropriate before it is provided. The act mandates that by January 1, 2027, utilization review entities (entities that perform prior authorization for employers, insurers, or other health benefit providers) must accept and respond to prior authorization requests electronically, using specific national standards for prescription drugs and a free, secure electronic portal for other healthcare services, without forcing providers to use a particular portal. It also establishes strict timelines for these entities to make decisions on urgent requests within 24 hours, emergency requests within two hours, and regular requests within 14 calendar days, while also exempting pre-hospital transportation and emergency services from prior authorization and allowing a grace period for notification of emergency admissions. Furthermore, the bill prohibits prior authorization for cesarean sections, vaginal deliveries, and neonatal intensive care services, prevents retroactive denial of prior authorization unless based on fraud, and ensures that approved prior authorizations remain valid for the duration of treatment for chronic conditions. Healthcare providers are granted the right to appeal adverse determinations, with expedited processes for emergency or urgent appeals, and the option for a peer-to-peer review within 48 hours. Finally, utilization review entities must publicly disclose their prior authorization requirements online, notify providers of any changes, and submit annual reports on their practices to the commissioner of insurance, who will then publish this data.

Business and Industry

Financial Institutions and Insurance (Senate)

https://kslegislature.gov/li/b2025_26/measures/sb330/