INSURANCE; PRIOR AUTHORIZATIONS
Sponsored By: SENATE LABOR & COMMERCE
Became Law
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Bill Overview
Analyzed Economic Effects
7 provisions identified: 7 benefits, 0 costs, 0 mixed.
No step therapy for Stage 4 cancer
Beginning January 1, 2027, insurers cannot force step therapy for people with Stage 4 metastatic cancer when the drug matches FDA approval, an NCCN Category 1 or 2A listing, or strong medical literature. Insurers must post an easy exception process and grant exceptions when past required drugs failed, lost effect, or caused adverse events, or when the provider attests the drug is needed to save the patient’s life. Drug samples do not count as a trial. If an exception is granted and the drug is covered by the plan, the insurer must authorize dispensing and coverage.
Faster prior authorization answers and approvals
Beginning January 1, 2027, insurers must decide standard prior authorizations in 72 hours (non‑fax) or 72 hours excluding weekends (fax). Expedited requests must be decided in 24 hours. If a request is missing details, the insurer must ask the provider within 1 day (expedited) or 3 days (standard). The insurer must set a due date 5–14 working days after receipt and tell the provider and covered person what is needed. If the insurer misses any required time limit, the request is approved. Insurers must also confirm the date and time they received each request.
Longer approvals for ongoing care
Beginning January 1, 2027, prior authorizations for chronic conditions last at least 12 months while you stay covered. They renew for another 12 months if the plan is unchanged and your provider certifies compliance. All other authorizations last 90 days or longer if clinically needed. Insurers must give providers 60 days’ written notice before changing prior authorization rules and update their websites before changes start.
Oversight, insurer reports, and penalties
Beginning January 1, 2027, the insurance director checks compliance at least every two years and can order fixes. The director can fine insurers up to $25,000 per violation and suspend or revoke a certificate for serious or repeated violations. Insurers must file a yearly prior authorization report with response times, criteria used, API status, approvals and denials with reasons, appeals and outcomes, and top 20 codes’ approval times by diagnosis and demographics. The director may adopt rules to carry out this law, and that rulemaking authority takes effect immediately. Most other parts take effect January 1, 2027.
Online rules and electronic prior authorization
Beginning January 1, 2027, insurers must run an electronic prior authorization interface that follows federal CMS standards. It must say when authorization is required, list needed documents, and send and receive requests and decisions for care and drugs. It must show covered alternative drugs and mark denials or substitutions as appealable. Insurers must post plain‑language, evidence‑based standards online, update them at least yearly, and use the rule that favors the covered person when standards conflict. The law also defines terms like chronic condition and expedited request so people know who can get faster review.
Protects coverage for religious nonmedical care
The law protects coverage for services from religious nonmedical providers when an insurer chooses to cover them. Insurers cannot require medical eligibility rules, force an exam by a health care provider, or deny coverage only because the religious provider does not supply medical records.
Stronger appeals and clinical peer review
Beginning January 1, 2027, your provider can ask for a clinical peer review of a prior authorization decision. The reviewer must have the right expertise, review all notes, and the insurer must share the reviewer’s qualifications on request. If a prior authorization is denied, the insurer must tell you and your provider why, cite the criteria, list missing information, and explain how and when to appeal with contact details.
Sponsors & Cosponsors
Sponsor
SENATE LABOR & COMMERCE
Affiliation unavailable
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
No roll call votes available for this bill.
Actions Timeline
(S) EFFECTIVE DATE(S) OF LAW SEE CHAPTER
7/30/2025Senate(S) LAW W/O GOV SIGNATURE 7/15 CHAPTER 21 SLA 25
7/30/2025Senate(S) MANIFEST ERROR(S)
7/30/2025Senate(S) 3:20 P.M. 6/23/25 TRANSMITTED TO GOVERNOR
7/30/2025Senate(H) VERSION: CSSB 133(L&C)
5/18/2025House(H) RETURN TO (S), TRANSMIT TO GOV NEXT
5/18/2025House(H) EFFECTIVE DATE(S) SAME AS PASSAGE
5/18/2025House(H) PASSED ON RECONSIDERATION Y40
5/18/2025House(H) RECON SAME DAY UC - IN THIRD READING
5/18/2025House(H) RUFFRIDGE NOTICE OF RECONSIDERATION
5/18/2025House(H) EFFECTIVE DATE(S) SAME AS PASSAGE
5/18/2025House(H) PASSED Y40
5/18/2025House(H) READ THE THIRD TIME CSSB 133(L&C)
5/18/2025House(H) ADVANCED TO THIRD READING Y33 N7
5/18/2025House(H) ADVANCED TO THIRD READING NEXT CALENDAR
5/18/2025House(H) READ THE SECOND TIME
5/18/2025House(H) RULES TO CALENDAR 5/18/2025
5/18/2025House(H) FIN REFERRAL REMOVED
5/16/2025House(H) FN1: ZERO(CED)
5/16/2025House(H) DP: BURKE, CARRICK, SADDLER, NELSON, FIELDS, HALL
5/16/2025House(H) L&C RPT 6DP
5/16/2025House(H) Moved CSSB 133(L&C) Out of Committee -- Delayed to 15 min Following Session --
5/14/2025House(H) LABOR & COMMERCE at 03:15 PM BARNES 124
5/14/2025HouseAudio/Video
5/14/2025House(H) L&C, FIN
5/13/2025House
Bill Text
Enrolled SB 133
5/18/2025
CSSB 133(L&C)
4/4/2025
SB 133
3/17/2025