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ARIZONA HOUSE OF REPRESENTATIVES57th Legislature, 2nd Regular Session |
House: HHS DPA/SE 12-0-0-0 |
HB 2250: prior authorizations; habilitative services
S/E: prior authorizations; timelines; disclosures; access
Sponsor: Representative Bliss, LD 1
Caucus & COW
Summary of the Strike-Everything Amendment to HB2250
Overview
Effective January 1, 2027, changes the notification timeframes for prior authorization decisions or adverse determinations for urgent and non-urgent services.
History
A prior authorization requirement means 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, including preadmission review, pretreatment review, prospective review or utilization review procedures conducted by a health care services plan or its utilization review agent prior to health care service provision, precluding case management or step therapy protocols.
A health care services plan or its utilization review agent may impose a prior authorization requirement for health care services provided to an enrollee. If the prior authorization request is denied, the health care services plan or its utilization review agent must state the specific reason for the denial. On a denial of a prior authorization request, the enrollee and the provider may exercise the review and appeal rights granted under the health care appeals process. For prior authorization requests concerning health care services that are not urgent health care services, the health care services plan or its utilization review agent must notify the provider of the prior authorization decisions or adverse determinations no later than 5 days for urgent requests and 14 days for non-urgent requests after receipt of necessary information (A.R.S. §§ 20-3402, 20-3404).
The Centers for Medicare and Medicaid Services (CMS) Interoperability and Prior Authorization Final Rule emphasizes the need to improve health information exchange to achieve appropriate and necessary access to health records for patients, healthcare providers, and payers. Additionally, it focuses on efforts to improve prior authorization processes through policies and technology, to help ensure that patients remain at the center of their own care. Timeframes would be 72 hours for expedited requests, unless a shorter minimum timeframe is established under applicable state and 7 calendar days for standard requests with the possibility of an extension to up to 14 days in certain circumstances (CMS 0057-F).
Provisions
1. Changes the timeframe for when a health care services plan or its utilization review agent must notify a provider of its prior authorization decision or adverse determination from 5 days to 72-hours for urgent health care services, unless a shorter timeframe applies for urgent health care services under the CMS Interoperability Rule. (Sec. 2)
2. Changes the timeframe for when a health care services plan or its utilization review agent must notify a provider of its prior authorization decision or adverse determination from 14 days to 7 calendar days for urgent health care services, unless a shorter timeframe applies for non-urgent health care services under the CMS Interoperability Rule. (Sec. 2)
3. Requires the Department of Insurance and Financial Institutions (DIFI) to compile reports related to qualified health plans as required for CMS prior authorization metric reporting overview and template requirements. (Sec. 2)
4. Requires DIFI to make available on its public website links to each qualified health plan's data for the prior calendar year that is reported by December 31 of each year. (Sec. 2)
5. Requires providers to access and submit uniform prior authorization requests through the applicable electronic software system or data portal of the health care services plan or its utilization review agent. (Sec. 1)
6. Requires health care services plan or its utilization review agent to have emergency after-hours procedures to ensure the timely receipt and processing of prior authorization requests. (Sec. 1)
7. Contains an effective date of January 1, 2027. (Sec. 3)
8. Makes conforming changes. (Sec. 1, 2)
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12. Initials AG HB 2250
13. 2/13/2026 Page 0 Caucus & COW
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