Title 26 — Title 26 — Insurance Code
56 chapters · 1,242 sections in this title.
W.S. § 26-55-101 Short title
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Short title. This act shall be known and may be cited as the "Ensuring Transparency in Prior Authorization Act."
W.S. § 26-55-102 (a) Definitions
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(a) Definitions. As used in this act: (i) "Adverse determination" means a decision by a health insurer or contracted utilization review entity to deny, reduce or terminate benefit coverage for health care services furnished or proposed to be furnished because the services are not…
W.S. § 26-55-103 requirements
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requirements. Disclosure and review of prior authorization (a) Each health insurer or contracted utilization review entity shall make any current prior authorization requirements and restrictions easily accessible on its website to enrollees, health care providers and the general…
W.S. § 26-55-104 determinations
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determinations. Persons qualified to make adverse (a) Each health insurer or contracted utilization review entity shall ensure that all adverse determinations are made by a physician or other appropriate licensed health care provider who has: (i) Sufficient medical knowledge in a…
W.S. § 26-55-105 determination
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determination. Consultation after issuing an adverse After issuing an adverse determination, the health insurer or contracted utilization review entity shall provide the opportunity to the health care provider to discuss the medical necessity of the health care service with the p…
W.S. § 26-55-106 appeals
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appeals. Requirements applicable to persons reviewing (a) Each health insurer or contracted utilization review entity shall ensure that all appeals of adverse determinations are reviewed by a physician or other appropriate licensed health care provider who has: (i) Sufficient med…
W.S. § 26-55-107 Health insurer or contracted utilization review entities' obligations regarding prior authorization for nonurgent health care services If a health insurer or contracted utilization review entity requi
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Health insurer or contracted utilization review entities' obligations regarding prior authorization for nonurgent health care services If a health insurer or contracted utilization review entity requires prior authorization of a health care service, the health insurer or contract…
W.S. § 26-55-108 Health insurer or contracted utilization review entities' obligations with respect to prior authorizations for urgent health care services
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Health insurer or contracted utilization review entities' obligations with respect to prior authorizations for urgent health care services. Each health insurer or contracted utilization review entity shall make an authorization or adverse determination concerning urgent health ca…
W.S. § 26-55-109 No prior authorization for medications for opioid use disorder
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No prior authorization for medications for opioid use disorder. No health insurer or contracted utilization review entity shall require prior authorization for the provision of medications for opioid use disorder.
W.S. § 26-55-110 Length of authorization generally; revocation of prior authorizations prohibited; length of authorization for chronic or long-term care conditions
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Length of authorization generally; revocation of prior authorizations prohibited; length of authorization for chronic or long-term care conditions. (a) Each authorization shall have the following timelines: (i) Outpatient service prior authorizations shall be valid for a period o…
W.S. § 26-55-111 Continuity of care for enrollees
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Continuity of care for enrollees. (a) On receipt of all necessary information documenting an authorization from the enrollee, previous health insurer or the enrollee's health care provider, a health insurer or contracted utilization review entity shall honor an authorization gran…
W.S. § 26-55-112 requirements
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requirements. Provider exemptions from prior authorization (a) A health care provider, as identified by a unique national provider identifier, shall be granted a twelve (12) month or one (1) year exemption from completing a prior authorization request for a health care service, e…
W.S. § 26-55-113 Prior authorization for rehabilitative or habilitative services
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Prior authorization for rehabilitative or habilitative services. (a) A health insurer or contracted utilization review entity shall not require prior authorization for rehabilitative or habilitative services including, but not limited to, physical therapy services or occupational…