§ 23-99-1704 — Prior authorization

(a) A contracting entity shall not require prior authorization for: (1) Ground or air prehospital transportation; or (2) Ground or air emergent or urgent ambulance transportation from one (1) hospital or medical facility to another hospital or medical facility in order to obtain medically needed diagnostic or medical therapeutic services. (b) A contracting entity may require a prior authorization for non-urgent and nonemergent ground or air ambulance services by an air ambulance. (c) A decision on a request for prior authorization by a transportation benefit manager shall include a determination as to whether or not the individual is covered by a health benefit plan and eligible to receive the requested ambulance services under the health benefit plan as a subscriber. (d) A transportation benefit manager shall not rescind, limit, condition, or restrict a prior authorization based upon medical necessity. (e) A transportation benefit manager shall provide ambulance providers with a direct contact number, that is answered twenty-four (24) hours a day, seven (7) days a week, with which to obtain prior authorization for ambulance services. (f) (1) Determination of prior authorization for ambulance services between medical facilities shall be provided or declined within twenty (20) minutes of the ambulance provider's or medical facility's placing a request for determination. (2) If not denied within twenty (20) minutes, the ambulance services shall be deemed automatically approved. (g) If a medical facility is required to obtain a prior authorization on behalf of the ambulance provider, the transportation benefit manager shall advise the ambulance provider of the requirement before ambulance transport. This section was enacted as 22-99-1604; however, it has been included in Title 23 to reflect the apparent intent of the legislature.

Legislative History

Added by Act 2023, No. 578,§ 1, eff. 8/1/2023.