ARIZONA HOUSE OF REPRESENTATIVES

Fifty-fourth Legislature

Second Regular Session

House: HHS DP 9-0-0-0

HB 2532: prior authorization; uniform request form

Sponsor:  Representative Shah, LD 24

House Engrossed

Overview

Requires the Arizona Department of Insurance (DOI) on or before January 1, 2021, to approve a uniform prior authorization request form that healthcare services plan 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.    ☐ Prop 105 (45 votes) ☐ Prop 108 (40 votes) ☐ Emergency (40 votes) ☐ Fiscal NoteModifies the definition of health care service. (Sec. 1)

2.    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)

3.    Requires DOI on or before January 1, 2021 to approve a uniform prior reauthorization request form for prescription drugs, devices or durable medical equipment and a uniform prior authorization request form for all other health care procedures, treatments and services.     (Sec. 3)

4.    States that on or before January 1, 2022, all providers must use only the approved uniform prior authorization request forms and all health care services plan and utilization review agents must accept and process for prior authorization requests submitted using the approved uniform prior authorization requests forms. (Sec. 3)

5.    Requires that all prior authorization requests forms that are submitted after January 1, 2022 are invalid unless the requests are submitted on the approved uniform prior authorization request form. (Sec. 3)

6.    Specifies that the uniform prior authorization request forms must:

a)    Not exceed two printed pages; and

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

7.    Clarifies that the two-page limit stated in the above-mentioned provision does not apply to or include a provider's notes or documentation that the provider submits in support of the prior authorization request. (Sec. 3)

8.    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;

ii.     Any national standards relating to electronic prior authorization;

iii.    Any other form adopted by the Director or another state agency; and

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

9.    Specifies that the above-mentioned provisions do not prohibit a payor or any entity acting for a payor under contract with the payor from using a prior authorization methodology that uses an internet webpage, internet webpage portal or a similar electronic, intern and web-based system if the methodology is consistent with the uniform prior authorization request forms approved by the Director of DOI. (Sec. 3)

10.  Defines terms. (Sec. 1 and 3)

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

 

 

 

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Initials IG/AG              House Engrossed

 

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