ARIZONA HOUSE OF REPRESENTATIVES

Fifty-fifth Legislature

First Regular Session

House: HHS DP 9-0-0-0

HB 2621: prior authorization; uniform request forms

Sponsor:  Representative Shah, LD 24

Caucus & Cow

Overview

Requires the Arizona Department of Insurance (DOI), by 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.

Statute 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)).

If a healthcare service plan contains a prior authorization requirement, 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 form approved by DOI. (Sec. 2)

3.   Requires DOI, by January 1, 2022, to approve a uniform prior authorization 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 all providers, by January 1, 2023, must use only the approved uniform prior authorization request forms and that all health care services plans utilization review agents must accept and process prior authorization requests submitted using the approved uniform prior authorization request forms. (Sec. 3)

5.   Stipulates that prior authorization requests that are submitted on or after January 1, 2023 are invalid unless the requests are submitted on the approved uniform prior authorization request forms. (Sec. 3)

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

a)   Not exceed two printed pages, not including a provider's notes or documentation that the provider submits in support of a prior authorization request; and

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

7.   States that in approving the uniform prior authorization request forms, DOI must:

a)   Consider the following:

i.   Any existing prior authorization request forms that the Centers for Medicaid and Medicare 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 of DOI (Director) or another state agency.

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

8.   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. (Sec. 3)

9.   Defines pharmacy benefit manager and provider. (Sec. 1 and 3)

10.  Makes technical and conforming changes. (Sec. 1 and 2)

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14.                    HB 2621

15.  Initials EB  Page 0 Caucus & COW

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