HB775 - Prior authorization; impose certain requirements on health insurance issuers regarding.

2 Co-Sponsors

An Act To Enact The Mississippi Prior Authorization Reform Act; To Establish The Legislative Findings Of The Act; To Provide The Applicability And Scope Of The Act; To Require Health Insurance Issuers To Maintain A Complete List Of Services For Which Prior Authorizations Are Required; To Require Health Insurance Issuers To Make Any Current Prior Authorization Requirements And Restrictions Readily Accessible And Posted On Its Website; To Set Requirements For The Clinical Review Criteria Of Health Insurance Issuers; To Prohibit Health Insurance Issuers From Denying A Claim For Failure To Obtain Prior Authorization If The Prior Authorization Requirement Was Not In Effect On The Date Of Service On The Claim; To Require Health Insurers To Make Certain Prior Authorization Statistics Available On Their Website; To Require Health Insurance Issuers To Make Available A Standardized Electronic Prior Authorization Request Transaction Process By January 1, 2025; To Require All Health Care Professionals And Health Care Providers To Use That Process Not Later Than January 1, 2027; To Establish Certain Requirements On Health Insurance Issuers For Prior Authorizations In Nonurgent Circumstances And Urgent Circumstances; To Provide Certain Qualifications Of Physicians Qualified To Make Adverse Determinations; To Require Health Insurance Issuers To Give Certain Notifications When Making An Adverse Determination; To Establish The Qualifications For Personnel Who Review Appeals Of Prior Authorizations; To Require Health Insurance Issuers To Periodically Review Their Prior Authorization Requirements And To Consider Removal Of These Requirements In Certain Cases; To Provide That A Health Insurance Issuer May Not Revoke Or Further Limit, Condition Or Restrict A Previously Issued Prior Authorization While It Remains Valid Under This Act Unless Certain Exclusions Are Applicable; To Provide How Long Prior Authorization Approvals Shall Be Valid; To Provide How Long The Prior Authorizations For Chronic Conditions Shall Be Valid; To Establish The Procedure For The Continuity Of Prior Approvals From Previous Health Insurance Issuers To Current Issuers; To Provide That A Failure By A Health Insurance Issuer To Comply With The Deadlines And Other Requirements Specified In This Act Shall Result In Any Health Care Services Subject To Review To Be Automatically Deemed Authorized By The Health Insurance Issuer Or Its Contracted Private Review Agent; To Authorize The Department Of Insurance To Issue Cease And Desist Orders To Health Insurance Issuers Or Private Review Agents; To Authorize The State Department Of Insurance To Impose Upon A Private Review Agent, Health Benefit Plan Or Health Insurance Issuer An Administrative Fine Not To Exceed $10,000 Per Violation Of The Act; To Require Health Insurance Issuers To Report To The Department Certain Data; To Require Health Insurance Issuers To Notify The Commissioner Of Insurance Of Suspected Submissions Of False Requests For Prior Authorization; To Require The Commissioner To Have An Administrative Hearing On Such Matters To Resolve The Issue; To Amend Section 41-83-31, Mississippi Code Of 1972, To Conform And To Set Certain Qualifications And Time Constraints For Physicians Making Adverse Determinations Through Any Program Of Utilization Review; To Amend Sections 41-83-1, 41-83-3, 41-83-13, 41-83-21, 83-1-101 And 83-9-6.3, Mississippi Code Of 1972, To Conform With The Provisions Of This Act; To Bring Forward Sections 41-83-5, 41-83-7, 41-83-9, 41-83-11, 41-83-15, 41-83-17, 41-83-19, 41-83-23, 41-83-25, 41-83-27 And 41-83-29, Mississippi Code Of 1972, For The Purpose Of Possible Amendment; And For Related Purposes.