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Legislative Year: 2022 Change
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Bill Detail: SB22-078

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Title Prior Authorization Exemption Health-care Provider
Status House Second Reading Special Order - Laid Over Daily - No Amendments (05/09/2022)
Bill Subjects
  • Health Care & Health Insurance
House Sponsors S. Bird (D)
T. Geitner (R)
Senate Sponsors J. Ginal (D)
B. Kirkmeyer (R)
House Committee Health and Insurance
Senate Committee Health and Human Services
Date Introduced 01/19/2022
Summary

With regard to health-care services, section 1 of the bill requires
a health insurance carrier (carrier) or private utilization review
organization, as applicable, to offer a provider with at least a 95%

approval rate of prior authorization requests over the prior 12 months an
alternative to prior authorization requirements, including an exemption
from the requirements, incentive awards, or other innovative programs,
to reward provider compliance.
With regard to drug benefits, section 2 requires a carrier or
pharmacy benefit management firm, as applicable, to offer the same types
of alternatives to prior authorization requirements to a provider who has
at least a 95% approval rate of prior authorization requests over the prior
12 months.

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