Bills › 91st General Assembly
Relating to prior authorization and utilization review organizations
Sponsored by the Senate Health and Human Services Committee
Topics:Health careInsurance
Where it is now
- Done: IntroducedJanuary 16, 2025
- Done: SubcommitteeJanuary 16, 2025
- Done: Senate committeeFebruary 6, 2025
- Done: Passes the SenateApril 16, 202547–0
- Skipped: House committeeSkipped
- Done: Passes the HouseFebruary 20, 202592–0
- Done: To the GovernorMay 19, 2025
- Done: Signed into lawMay 27, 2025
HF 303 became law → The same legislation passed as HF 303, so this version was set aside. Go to HF 303 What’s a funnel?
What’s in it
AI summary Organizations that review health insurance requests must now give doctors answers much faster, sometimes within 48 hours for urgent needs. These groups must also look at their rules every year and stop requiring permission for medical services that are almost always approved. Finally, the insurance commissioner will receive reports on these reviews to make sure everything is working correctly.1
Read the official explanation
This bill relates to prior authorization and utilization review organizations. The bill requires a utilization review organization (organization) to provide a determination to a request for prior authorization (authorization) from a health care provider (provider) within 48 hours after receipt for urgent requests or within 10 calendar days for nonurgent requests, unless there are complex or unique circumstances, or the organization is experiencing an unusually high volume of authorization requests, then an organization must respond within 15 calendar days. Within 24 hours after receipt of an authorization request, the organization shall notify a provider of, or make available, a receipt for the authorization request. The bill requires an organization to conduct an annual review and submit the findings in a report to the commissioner of insurance (commissioner). The requirements for the report are detailed in the bill. The bill also requires an organization to annually review all health care services for which a health benefit plan (plan) requires an authorization, and to eliminate authorization requirements for health care services for which authorization requests are so routinely approved that the authorization requirement is not justified as it does not promote health care quality or reduce health care spending. An organization shall submit an annual report containing the findings of both reviews to the commissioner, and shall include all of the information detailed in the bill. The commissioner shall submit an annual report to the general assembly containing a summary and analysis of the information in the reports. Complaints regarding an organization’s compliance with the bill may be directed to the insurance division, and the insurance division shall notify an organization of all complaints received regarding the organization. Complaints received under the bill shall not be considered public records.
Why it matters. Health care providers would receive faster decisions on urgent and nonurgent requests for prior authorization from utilization review organizations. These organizations must also review their services annually and remove authorization requirements for treatments that are routinely approved and do not improve quality or reduce spending. The insurance division would oversee these organizations and manage complaints regarding their compliance with these new rules.2
Changed since by amendments S-3015, S-3014; see Amendments.
Senate subcommittee
Named January 16, 2025 (as SSB 1016). On January 23, 2025 it recommended passage.
Three legislators hear a bill first and recommend what the committee should do; it’s the best time to weigh in. How to take part
1 written public comment to its subcommittee: January 23, 2025 (1) · on the Legislature’s site
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Tried before
Study bill
91st General Assembly
Earlier and later bills are matched by wording or an identical title.
Tried before
This idea has been filed in an earlier General Assembly. None became law, though one got through a chamber.
- HF 2488 Relating to prior authorizations and exemptions by health benefit plans and utilization re…90th General Assembly · Passed both chambers · nearly identicalPassed a chamber
Similar bills this General Assembly
- SF 562 Relating to utilization review organizations, prior authorizations and exemptions, medical…91st General Assembly · In committeeSimilar
Matched by wording or an identical title.