Bill > HB1199

This bill requires utilization review organizations, which are entities that review the appropriateness of medical care, and health carriers, which are insurance companies, to conduct annual reviews and submit detailed reports to the Division of Insurance regarding their prior authorization processes for health care services, excluding dental and pharmaceutical services. These reports must include statistics on the approval and denial rates for both urgent and non-urgent prior authorization requests, as well as the average and median times taken to make determinations. Furthermore, the bill mandates that these organizations and carriers must eliminate prior authorization requirements for any health care service if the requests are overwhelmingly approved, indicating the requirement doesn't effectively improve quality or reduce costs enough to justify the administrative burden. If a prior authorization requirement is eliminated, the organizations and carriers must report on the number of requests for that service, the number of providers who submitted requests, and any significant changes in the average number of claims submitted per provider for that service. The Division of Insurance will then publish these reports on its website within sixty days of receiving them.

Health and Social Services

https://sdlegislature.gov/#/Session/Bill/26947