HB420 - Mississippi Prior Authorization Reform Act; create.

1 Co-Sponsor

An Act To Create The Mississippi Prior Authorization Reform Act; To Provide The Scope Of The Act And Definitions; To Require The Department Of Insurance To Promulgate Rules And Regulations That Provide For The Disclosure And Review Requirements For Prior Authorization; To Provide That If Any Health Insurance Issuer Requires Prior Authorization Of A Health Care Service, The Insurer, Or Its Designee Utilization Review Organization, Shall, By January 1, 2026, Make Available A Standardized Electronic Prior Authorization Request Transaction Process; To Require All Health Care Professionals And Providers To Use The Standardized Electronic Prior Authorization Request Transaction Process By January 1, 2028; To Provide The Time For Either Approving Or Providing An Adverse Determination To A Prior Authorization Request In Both Nonurgent And Urgent Situations; To Provide The Personnel Qualified To Make Adverse Determinations; To Require The Department Of Insurance To Promulgate Rules And Regulations That Provide The Notification Requirements To An Enrollee And An Enrollee's Health Care Professional And Provider If A Health Insurance Issuer Makes An Adverse Determination; To Provide The Personnel Who Are Qualified To Review Appeals Of Adverse Determinations; To Require A Health Insurance Issuer To Periodically Review Its Prior Authorization Requirements; To Require The Department Of Insurance Promulgate Rules And Regulations That Provide For The Revocation Of Prior Authorizations; To Provide How Long The Length Of Approvals May Be For Prior Authorizations; To Require The Department Of Insurance To Promulgate Rules And Regulations For How Long The Approval Of A Prior Authorization May Last For A Chronic Condition; To Require The Department Of Insurance To Promulgate Rules And Regulations That Provide How Long A Health Insurance Issuer Must Honor The Prior Authorization Granted To An Enrollee From A Previous Health Insurance Issuer; To Provide That The Failure By A Health Insurance Issuer To Comply With Deadlines And Other Requirements Shall Result In Any Health Care Services Subject To Review Being Automatically Deemed Authorized By The Health Insurance Issuer; To Provide For The Enforcement And Administration Of This Act; To Provide The Reports That Must Be Filed With The Department Of Insurance Each Year; To Authorize The Department Of Insurance To Promulgate Any Other Rules And Regulations As Necessary To Effectuate The Mississippi Prior Authorization Act; To Bring Forward Sections 41-83-31 And 83-9-6.3, Mississippi Code Of 1972, For The Purpose Of Possible Amendment; And For Related Purposes.