§ 23-99-1121 — Duration of prior authorization exemption

(a) Unless a prior authorization exemption is continued for a longer period of time by a healthcare insurer under § 23-99-1120(f) , a healthcare provider's exemption from prior authorization requirements under § 23-99-1120 remains in effect until the later of: (1) The thirtieth day after the date the healthcare insurer notifies the healthcare provider of the healthcare insurer's determination to rescind the exemption as described under § 23-99-1122 , if the healthcare provider does not appeal the healthcare insurer's determination within thirty (30) days of notification of the determination; (2) If the healthcare provider appeals the determination within thirty (30) days of notification of the determination, the fifth day after the date an independent review organization affirms the healthcare insurer's determination to rescind the exemption; or (3) Twelve (12) months after the effective date of the exemption. (b) If a healthcare provider appeals the determination to rescind the exemption more than thirty (30) days after notification of the determination and the independent review organization overturns the rescission, the healthcare provider's exemption is restored the fifth day after the date of the independent review organization's decision, and the exemption remains in effect for twelve (12) months after restoration unless rescinded under § 23-99-1122 . (c) If a healthcare insurer does not finalize a rescission determination as specified in subsection (a) of this section, then the healthcare provider is considered to have met the criteria under § 23-99-1120 to continue to qualify for the exemption. (d) A healthcare provider shall not rely on another healthcare provider's exemption except when the healthcare provider with an exemption is the healthcare provider that orders healthcare services that are rendered by a healthcare provider without an exemption.

Legislative History

Added by Act 2023, No. 575,§ 5, eff. 8/1/2023.