Relating to reimbursement for health care services provided after receipt of a prior authorization, and including applicability provisions

This bill is related to reimbursement for health care services provided after receipt of a prior authorization. Except in a case where the health care provider or the covered person has committed fraud, the bill prohibits a utilization review organization from revoking, or imposing a limitation, condition, or restriction on a prior authorization after the date on which a health care provider provides a health care service to a covered person per the prior authorization. The bill requires a health carrier to reimburse a health care provider at the contracted reimbursement rate for a health care service provided by the provider to a covered person per a prior authorization. “Covered person”, “health benefit plan”, “health care provider”, “health care services”, “health carrier”, “prior authorization”, “utilization review”, and “utilization review organization” are defined in the bill. The bill provides that a prior authorization for a specific health care service for a specific covered person shall be valid for not less than days from the date that the covered person’s health care provider receives the prior authorization from a utilization review organization, provided that during the days the covered person remains a participant in the same health benefit plan in which the covered person participated on the date the prior authorization was received by the health care provider. The commissioner of insurance may adopt rules as necessary to administer the bill. The bill applies to health benefit plans that are delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2023.