H.B. 323

1

HEALTH INSURANCE PRIOR AUTHORIZATION
2 2013 GENERAL SESSION
3 STATE OF UTAH
4 Chief Sponsor: Bradley G. Last
5 Senate Sponsor: ____________
6
7 LONG TITLE
8 General Description:
9 This bill amends the Insurance Code related to health insurance and prior authorization
10 forms for prescription drugs.
11 Highlighted Provisions:
12 This bill:
13 . defines terms;
14 . requires the commissioner of insurance to adopt rules by July 1, 2013, to
15 standardize the prior authorization forms required by health insurers for prescription
16 drugs;
17 . requires public input for the administrative rules; and
18 . requires the health insurers to accept the standard form and reply to the standard
19 form within two days after submission of the form.
20 Money Appropriated in this Bill:
21 None
22 Other Special Clauses:
23 None
24 Utah Code Sections Affected:
25 ENACTS:
26 31A-22-635.5, Utah Code Annotated 1953
27

28 Be it enacted by the Legislature of the state of Utah:
29 Section 1. Section 31A-22-635.5 is enacted to read:
30 31A-22-635.5. Uniform prescription drug prior authorization form.
31 (1) For purposes of this section, "health insurer" is as defined in Subsection
32 31A-22-634 (1).
33 (2) The commissioner shall on or before July 1, 2013, adopt an administrative rule to:
34 (a) prescribe a form for requesting prior authorization of prescription drug benefits;
35 (b) require a health insurer to use the form for any prior authorization of prescription
36 drug benefits required by the plan;
37 (c) require that the department and a health insurer make the form available
38 electronically; and
39 (d) allow a completed form to be submitted electronically by the prescribing provider
40 to the health insurer or the agent of the health insurer that manages or administers prescription
41 drug benefits.
42 (3) An administrative rule adopted by the commissioner under this section shall:
43 (a) limit the form, as printed, to not more than two pages;
44 (b) develop the form with input from interested parties received at one or more public
45 meetings; and
46 (c) take into consideration:
47 (i) any form for requesting prior authorization of benefits that is widely used in this
48 state or any form currently used by the department;
49 (ii) request forms for prior authorization of benefits established by the federal Centers
50 for Medicare and Medicaid Services; and
51 (iii) national standards, or draft standards, pertaining to electronic prior authorization
52 of benefits.
53 (4) If a health insurer fails to use or accept the form required by this section, or fails to
54 respond within two business days of receipt to a completed form submitted by a prescribing
55 provider, the prior authorization is considered granted by the health insurer.

Legislative Review Note
as of 2-8-13 11:39 AM

Office of Legislative Research and General Counsel

[Bill Documents]