RELATING TO PRIOR AUTHORIZATION.
Sponsored By: Gregg Takayama (Democratic)
Filed
Summary
Establishes a comprehensive regulatory framework for prior authorization process in the State, including disclosure and notice requirements for utilization review entities regarding their prior authorization requirements and restrictions; qualifications and criteria for prior authorization review and appeals personnel; prior authorization process for non-urgent and urgent health care services, including the time frame by which utilization review entities must render a decision; adverse determination and appeal processes; prohibition of prior authorization for emergency health care services and medication for opioid use disorder; payments to health care providers; length and duration of prior authorizations; and exemptions for certain health care providers. Requires health insurers to utilize NCPDP SCRIPT Standard electronic prior authorization transactions by 1/1/2026. Requires utilization review entities to submit annual reports to the Insurance Commissioner each year. Requires the Insurance Commissioner to submit annual reports to the Legislature. Requires the Insurance Commissioner to adopt rules by 1/1/2026.
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Bill Overview
No Economic Impacts Identified for this Bill
Sponsors & Cosponsors
Sponsor
Gregg Takayama
Democratic • House
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
No roll call votes available for this bill.
Actions Timeline
Carried over to 2026 Regular Session.
12/8/2025Introduced and Pass First Reading.
1/23/2025HouseReferred to HLT, CPC, FIN, referral sheet 3
1/23/2025HousePending introduction.
1/21/2025House
Bill Text
Original
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