ARIZONA HOUSE OF REPRESENTATIVES

Fifty-fourth Legislature

Second Regular Session

 

HB 2532: prior authorization; uniform request form

Sponsor:  Representative Shah, LD 24

Committee on Health & Human Services

Overview

Requires the Arizona Department of Insurance (DOI) on or before January 1, 2022, to approve a uniform prior authorization request form that healthcare services plans and utilization review agents will accept and process for prior authorization requests submitted from all providers and outlines requirements.

History

The mission of DOI is to protect Arizona citizens and businesses by promoting a safe, strong, innovative and competitive insurance marketplace.

Current law defines prior authorization requirement as a practice implemented by a health care services plan or its utilization review agent in which coverage of a health care service is dependent on an enrollee or a provider obtaining approval from the health care services plan before the service is performed, received or prescribed, as applicable. It includes preadmission review, pretreatment review, prospective review or utilization review procedures conducted by a health care services plan or its utilization review agent before providing a health care service; it does not include case management or step therapy protocols (A.R.S. § 20-3401(10)).

The healthcare services plan or its utilization review agent must make available to all providers on its website or provider portal a listing of all prior authorization requirements. The listing must clearly identify the specific health care services, drugs or devices to which a prior authorization requirement exists, including specific information or documentation that a provider must submit in order for the prior authorization request to be considered complete (A.R.S. § 20-3403(A)).

Provisions

1.    Defines pharmacy benefit manager. (Sec. 1)

2.    ☐ Prop 105 (45 votes) ☐ Prop 108 (40 votes) ☐ Emergency (40 votes) ☐ Fiscal NoteHealth care services include:

a)    A health care procedure, treatment or service that is covered under the health care services plan; or

b)    A prescription drug, device or durable medical equipment that is covered under the health care services plan. (Sec. 1)

3.    Specifies that a health care services plan or its utilization review agent must allow providers to access the uniform prior authorization request form approved by DOI. (Sec. 2)

4.    Requires DOI on or before January 1, 2022 to approve a uniform prior reauthorization request form that health care services plan and utilization review agents must accept and process for prior authorization requests submitted from all providers and that all providers are required to use. (Sec. 3)

5.    Specifies that the uniform prior authorization request form must:

a)    Not exceed two printed pages; and

b)    Meet the electronic submission and acceptance requirements as prescribed by law.       (Sec. 3)

6.    Stipulates that in approving the uniform prior authorization request form, DOI must both:

a)    Consider the following:

i.      Any existing prior authorization request forms that the Centers for Medicare and Medicaid Services or the U.S. Department of Health and Human Services has developed; and

ii.     Any national standards relating to electronic prior authorization.

b)    Seek input from interested stakeholders, including providers, health care services plans, utilization review agents, pharmacists and pharmacy benefit managers. (Sec. 3)

7.    Makes technical and conforming changes. (Sec. 1)

 

 

 

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Initials IG/AG              Health & Human Services

 

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