5267-S2.E AMH HCW H2223.1

E2SSB 5267  - H COMM AMD
     By Committee on Health Care & Wellness

ADOPTED 04/11/2013

     Strike everything after the enacting clause and insert the following:

"NEW SECTION.  Sec. 1   (1) A work group is formed to develop criteria to streamline the prior authorization process for prescription drugs, medical procedures, and medical tests, with the goal of simplification and uniformity.
     (2) The work group shall be cochaired by the chair of the senate health care committee and the chair of the house of representatives health care committee, and membership of the work group shall be determined by the cochairs, not to exceed eleven participants.
     (3) The work group shall examine elements that may include the following:
     (a) National standard transaction information, such as HIPAA 278 standards, for sending or receiving authorizations electronically;
     (b) Standard transaction information and uniform prior authorization forms;
     (c) Clean, uniform, and readily accessible forms for prior authorization including determining the appropriate number of forms;
     (d) A core set of common data requirements for nonclinical information for prior authorization and electronic prescriptions, or both;
     (e) The prior authorization process, which considers electronic forms and allows for flexibility for carriers to develop electronic forms; and
     (f) Existing prior authorization forms by insurance carriers and by state agencies, in developing the uniform prior authorization forms.
     (4) The work group must:
     (a) Establish timelines for urgent requests and timeliness for nonurgent requests;
     (b) Work on a receipt and missing information time frame;
     (c) Determine time limits for a response of acknowledgment of receipts or requests of missing information;
     (d) Establish when an authorization request will be deemed as granted when there is no response.
     (5) The work group must submit their recommendations to the appropriate committees of the legislature by November 15, 2013.
     (6) This section expires January 1, 2014.

NEW SECTION.  Sec. 2   The insurance commissioner shall adopt rules implementing the recommendations of the work group established in section 1 of this act. The rules must take effect no later than July 1, 2014."

     Correct the title.

EFFECT:  Requires the Insurance Commissioner to adopt rules implementing the recommendations of the work group. Requires the rules to take effect no later than July 1, 2014.

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