Bill > HB3010

This bill establishes new regulations for health carriers and utilization review entities regarding prior authorization of healthcare services, aiming to streamline the process and provide greater transparency. Key provisions include setting strict timeframes for health carriers to make utilization review decisions, with specific deadlines for notifying providers and enrollees of approvals or adverse determinations, and requiring written confirmation with clinical rationale for adverse decisions. The bill also extends the validity of prior authorization approvals for recurring services or maintenance medications for chronic conditions to at least six months or the length of treatment, whichever is shorter, and mandates that health carriers automatically deem services authorized if they fail to meet these notification deadlines. Furthermore, it requires utilization review entities to provide unique confirmation numbers and timestamps for prior authorization requests, mandates electronic submission and response for most requests, and introduces a requirement for health carriers to implement an application programming interface (API) for prior authorization submissions by January 1, 2027, with specific reporting requirements for approval and denial statistics. The bill also introduces an exemption from prior authorization requirements for providers who consistently have a high approval rate (90% or more) for their prior authorization requests, with provisions for auditing and rescinding this exemption under certain conditions, and prohibits denial or reduction of payment to a provider for a prior authorized service unless the provider misrepresented the service or failed to substantially perform it. Finally, it requires that contracts between health carriers and providers include provisions for continuing prior authorization approvals for enrollees transitioning from a previous health carrier for at least 180 days.

Health and Social Services

https://house.mo.gov/Bill.aspx?bill=HB3010&year=2026&code=R