§ 42:812 — Transparency in prior authorizations

§812. Transparency in prior authorizations
A. Beginning January 1, 2023:
(1) The office shall require every health plan offered through the office to furnish in
writing or provide electronically, within one business day of a written or oral request by a
healthcare provider, the medical criteria and any other requirements that must be satisfied in
order for a particular healthcare service, procedure, or prescription drug to be prior
authorized by the health plan.
(2) Upon the denial of a prior authorization by a health plan offered through the
office, the office shall require the health plan to provide with the written notification of the
denial either a copy of the applicable law, regulation, policy, procedure, or medical criterion
or guideline that was used by the health plan in the determination to deny the prior
authorization or instructions on how to access such law, regulation, policy, procedure, or
medical criterion or guideline on the website of the health plan that is publicly accessible.
B. The office may adopt rules in accordance with the Administrative Procedure Act
as are necessary for the implementation of this Section.

Legislative History

Acts 2022, No. 696, §1, eff. July 1, 2022.