.png)
Provides that a utilization review entity may only impose prior authorization requirements on less than 1% of unique health care services covered under the health plan overall and 1% of participating health care providers overall in a calendar year. Prohibits a utilization review entity from requiring prior authorization for certain health care services. Sets forth requirements for a utilization review entity that requires prior authorization of a health care service. Prohibits a health plan from imposing or enforcing a step therapy protocol requirement for a prescription drug that is approved by the federal Food and Drug Administration, prescribed for the approved purpose, and has an annualized net price of $100 or less. Provides that a claim for reimbursement for a covered service or item provided to a certain individual may not be denied on the sole basis that the referring provider is an out of network provider.
Authored by: Sen. Tyler Johnson, Sen. Ed Charbonneau, Sen. Liz Brown.
Co-Authored by: Sen. Linda Rogers, Sen. Michael Crider, Sen. Vaneta Becker, Sen. Jean Leising, Sen. Andrea Hunley, Sen. J.D. Ford, Sen. Scott Alexander, Sen. Eric Bassler, Sen. Mike Bohacek, Sen. Brian Buchanan, Sen. Gary Byrne, Sen. Dan Dernulc, Sen. Stacey Donato, Sen. Eric Koch, Sen. Randy Maxwell, Sen. Lonnie Randolph, Sen. James Buck, Sen. Justin Busch, Sen. Blake Doriot, Sen. Kyle Walker, Sen. Shelli Yoder, Sen. Rodney Pol, Sen. Andy Zay, Sen. Brett Clark, Sen. Fady Qaddoura, Sen. Ron Alting, Sen. Spencer Deery, Sen. Susan Glick, Sen. Travis Holdman, Sen. La Keisha Jackson, Sen. Rick Niemeyer, Sen. David Niezgodski, Sen. Jeff Raatz, Sen. Mark Spencer, Sen. Greg Taylor, Sen. Greg Walker, Sen. James Tomes, Sen. Cyndi Carrasco, Sen. Daryl Schmitt, Sen. Michael Young.
Bill Status: Opposite Committee
Comments