§ 26-55-103 — Disclosure and review of prior authorization requirements

(a) Each health insurer or contracted utilization review
entity shall make any current prior authorization requirements
and restrictions easily accessible on its website to enrollees,
health care providers and the general public. Each health
insurer or contracted utilization review entity shall directly
furnish those requirements and restrictions within twenty-four
(24) hours after being requested by a health care provider.
Requirements and restrictions provided or posted under this
subsection shall be described in detail but also in easily
understandable language. Content published by a third party and
licensed for use by a health insurer or contracted utilization
review entity may be made available through the health insurer
or contracted utilization review entity's secure password
protected website, provided that the access requirements of the
website do not unreasonably restrict access to any current prior
authorization requirements and restrictions.
(b) Each health insurer or contracted utilization review
entity shall not implement a new or amended prior authorization
requirement or restriction unless its website has been updated
to reflect the new or amended prior authorization requirement or
restriction.
(c) Each health insurer or contracted utilization review
entity shall provide affected contracted health care providers
and enrollees written notice of any new or amended prior
authorization requirement or restriction implemented under the
health insurer's medical policy or the health insurance contract
not less than sixty (60) days before the new or amended prior
authorization requirement or restriction is implemented.
(d) The department of insurance shall promulgate rules
requiring health insurers or contracted utilization review
entities to make statistics available to the public and the
department regarding prior authorizations and adverse
determinations. At a minimum, the statistics shall include
categories for:
(i) The health care provider specialty;
(ii) The medication or diagnostic test or procedure;
(iii) The indication offered;
(iv) The reason for the adverse determination;
(v) Whether the adverse determination was appealed;
(vi) Whether the adverse determination was upheld or
reversed on appeal;
(vii) The time between submission of the prior
authorization request and the authorization or initial adverse
determination.