House Bill 420

AN ACT TO CREATE THE MISSISSIPPI PRIOR AUTHORIZATION REFORM ACT; TO PROVIDE THE SCOPE OF THE ACT AND DEFINITIONS; TO REQUIRE THE DEPARTMENT OF INSURANCE TO PROMULGATE RULES AND REGULATIONS THAT PROVIDE FOR THE DISCLOSURE AND REVIEW REQUIREMENTS FOR PRIOR AUTHORIZATION; TO PROVIDE THAT IF ANY HEALTH INSURANCE ISSUER REQUIRES PRIOR AUTHORIZATION OF A HEALTH CARE SERVICE, THE INSURER, OR ITS DESIGNEE UTILIZATION REVIEW ORGANIZATION, SHALL, BY JANUARY 1, 2026, MAKE AVAILABLE A STANDARDIZED ELECTRONIC PRIOR AUTHORIZATION REQUEST TRANSACTION PROCESS; TO REQUIRE ALL HEALTH CARE PROFESSIONALS AND PROVIDERS TO USE THE STANDARDIZED ELECTRONIC PRIOR AUTHORIZATION REQUEST TRANSACTION PROCESS BY JANUARY 1, 2028; TO PROVIDE THE TIME FOR EITHER APPROVING OR PROVIDING AN ADVERSE DETERMINATION TO A PRIOR AUTHORIZATION REQUEST IN BOTH NONURGENT AND URGENT SITUATIONS; TO PROVIDE THE PERSONNEL QUALIFIED TO MAKE ADVERSE DETERMINATIONS; TO REQUIRE THE DEPARTMENT OF INSURANCE TO PROMULGATE RULES AND REGULATIONS THAT PROVIDE THE NOTIFICATION REQUIREMENTS TO AN ENROLLEE AND AN ENROLLEE'S HEALTH CARE PROFESSIONAL AND PROVIDER IF A HEALTH INSURANCE ISSUER MAKES AN ADVERSE DETERMINATION; TO PROVIDE THE PERSONNEL WHO ARE QUALIFIED TO REVIEW APPEALS OF ADVERSE DETERMINATIONS; TO REQUIRE A HEALTH INSURANCE ISSUER TO PERIODICALLY REVIEW ITS PRIOR AUTHORIZATION REQUIREMENTS; TO REQUIRE THE DEPARTMENT OF INSURANCE PROMULGATE RULES AND REGULATIONS THAT PROVIDE FOR THE REVOCATION OF PRIOR AUTHORIZATIONS; TO PROVIDE HOW LONG THE LENGTH OF APPROVALS MAY BE FOR PRIOR AUTHORIZATIONS; TO REQUIRE THE DEPARTMENT OF INSURANCE TO PROMULGATE RULES AND REGULATIONS FOR HOW LONG THE APPROVAL OF A PRIOR AUTHORIZATION MAY LAST FOR A CHRONIC CONDITION; TO REQUIRE THE DEPARTMENT OF INSURANCE TO PROMULGATE RULES AND REGULATIONS THAT PROVIDE HOW LONG A HEALTH INSURANCE ISSUER MUST HONOR THE PRIOR AUTHORIZATION GRANTED TO AN ENROLLEE FROM A PREVIOUS HEALTH INSURANCE ISSUER; TO PROVIDE THAT THE FAILURE BY A HEALTH INSURANCE ISSUER TO COMPLY WITH DEADLINES AND OTHER REQUIREMENTS SHALL RESULT IN ANY HEALTH CARE SERVICES SUBJECT TO REVIEW BEING AUTOMATICALLY DEEMED AUTHORIZED BY THE HEALTH INSURANCE ISSUER; TO PROVIDE FOR THE ENFORCEMENT AND ADMINISTRATION OF THIS ACT; TO PROVIDE THE REPORTS THAT MUST BE FILED WITH THE DEPARTMENT OF INSURANCE EACH YEAR; TO AUTHORIZE THE DEPARTMENT OF INSURANCE TO PROMULGATE ANY OTHER RULES AND REGULATIONS AS NECESSARY TO EFFECTUATE THE MISSISSIPPI PRIOR AUTHORIZATION ACT; TO BRING FORWARD SECTIONS 41-83-31 AND 83-9-6.3, MISSISSIPPI CODE OF 1972, FOR THE PURPOSE OF POSSIBLE AMENDMENT; AND FOR RELATED PURPOSES.

In the House of Representatives

• Henry Zuber III

  Sponsor

l9n doesn't hold this bill's text yet.

In the House of Representatives Jan 22 – Mar 5

1. Jan 22Referred to the House committee on Public Health and Human Services
2. Mar 5Died in committee in the House