Title 26 — Title 26 — Insurance Code

ORSA summary report. (a) Upon the commissioner's request, and no more than once each year, an insurer shall submit to the commissioner an ORSA summary report or any combination of reports that together contain the information described in the ORSA guidance manual, applicable to t…

Exemption. (a) An insurer shall be exempt from the requirements of this chapter, if: (i) The insurer has annual direct written and unaffiliated assumed premium, including international direct and assumed premium but excluding premiums reinsured with the federal crop insurance cor…

Contents of ORSA summary report. (a) The ORSA summary report shall be prepared consistent with the ORSA guidance manual, subject to the requirements of subsection (b) of this section. Documentation and supporting information shall be maintained and made available upon examination…

Confidentiality. (a) Documents, materials or other information, including the ORSA summary report, in the possession of or control of the department that are obtained by, created by or disclosed to the commissioner or any other person under this chapter, is recognized by this sta…

Sanctions. Any insurer failing, without just cause, to timely file the ORSA summary report as required in this chapter shall be required, after notice and hearing, to pay a penalty of two thousand five hundred dollars ($2,500.00) for each day's delay, to be recovered by the commi…

Applicability. The requirements of this chapter shall become effective on January 1, 2015. The first filing of the ORSA summary report shall be in 2015 pursuant to W.S. 26-51-105.

Licensure of pharmacy benefit managers. No person shall act or hold himself out as a pharmacy benefit manager in this state unless he obtains a license from the department. The department shall through rules establish license requirements and procedures for the licensing of pharm…

(a) Definitions. As used in this article: (i) "Claim" means a request from a pharmacy or pharmacist to be reimbursed for the cost of filling or refilling a prescription for a drug or for providing a medical supply or device; (ii) "Insurer" means the entity defined in W.S. 26-1102…

Pharmacy benefit manager audits. (a) Any pharmacy benefit manager or person acting on behalf of a pharmacy benefit manager who conducts an audit of a pharmacy shall follow the following procedures: (i) Provide written notice to the pharmacy not less than ten (10) business days be…

Maximum allowable cost; offering information and alternatives. (a) To place a drug on a maximum allowable cost list, a pharmacy benefit manager shall ensure that the drug is: (i) If the drug is a generically equivalent drug, rated "A" or "B" in the most recent version of the Unit…

Transparency; prohibitions. (a) A pharmacy benefit manager or an agent of a pharmacy benefit manager shall not: (i) Cause or knowingly permit the use of an advertisement, promotion, solicitation, representation, proposal or offer that is untrue, deceptive or misleading; (ii) Char…

Alternate reimbursement methodologies. All contracts between a pharmacy benefits manager and a pharmacy services administrative organization, or its contracted pharmacies, and all contracts directly between a pharmacy benefits manager and a pharmacy shall include a process to inv…

Certain claims excluded. W.S. 26-52-104 through 26-52-106 shall apply to all health benefit plan issuers and pharmacy benefit managers except those claims associated with the Wyoming Medicaid fee-for-service program, the Wyoming workers compensation division or those claims other…

Scope and applicability of chapter. The following provisions apply to situations where there is a contract between an insurer or the insurer's intermediary and a pharmacy regarding the payment of insurance claims for pharmacy services pursuant to W.S. 26-52-102(a)(ix) submitted t…

(a) Definitions. As used in this chapter: (i) "Applicable number of calendar days" means: (A) For claims submitted electronically, twenty- one (21) days; (B) For claims submitted in a manner other than electronically, thirty (30) days. (ii) "Clean claim" means a claim that has no…

Payment of claims to pharmacy providers. (a) A contract between an insurer or the insurer's intermediary and a pharmacy for prescription drug coverage offered by the insurer or the insurer's intermediary shall require the insurer or the insurer's intermediary to make payment to t…

(a) Definitions. As used in this chapter: (i) "Third party administrator" means a person who directly or indirectly underwrites, collects charges, collateral or premiums from, or adjusts or settles claims on residents of this state, in connection with life, annuity, health, or st…

Registration of third party administrators; rulemaking authority. No person shall act as a third party administrator in this state without a certificate of registration issued by the commissioner. The commissioner in compliance with the Wyoming Administrative Procedure Act shall …

Third party administrator fee. Every third party administrator registered with the department shall pay the fee provided for in W.S. 26-4-101(a)(xix).

Short title; applicability. (a) This chapter is known and may be cited as the Wyoming Insurance Corporate Governance Annual Disclosure Act. (b) The requirements of this act shall apply to all insurers and insurance groups domiciled in this state. (c) Nothing in this act shall be …

(a) Definitions. As used in this act: (i) "Corporate governance" means the system of rules, practices and procedures by which a corporation is managed by its directors and officers; (ii) "Corporate governance annual disclosure" or "CGAD" means a confidential report filed by an in…

Disclosure requirement. (a) An insurer, or the insurance group of which the insurer is a member, shall, no later than June 1 of each calendar year, submit to the commissioner a corporate governance annual disclosure that contains the information described in W.S. 26-54-105. Notwi…

Rules and regulations. The commissioner shall promulgate rules and regulations necessary to carry out the provisions of this act. The rules and regulations shall be consistent with this act and the commissioner shall be guided by the model regulations adopted by the National Asso…

disclosure. Contents of corporate governance annual (a) An insurer or insurance group shall have discretion over the manner in which a CGAD is submitted, provided the CGAD shall contain the material information necessary to permit the commissioner to gain an understanding of the …

Confidentiality. (a) Documents, materials or other information, including the CGAD, in the possession or control of the department that are obtained by, created by or disclosed to the commissioner or any other person under this act, are recognized by this state as being proprieta…

NAIC and third party consultants. (a) The commissioner may retain, at the insurer's expense, third party consultants, including attorneys, actuaries, accountants and other experts not otherwise a part of the commissioner's staff, as may be reasonably necessary to assist the commi…

Sanctions. Any insurer failing, without just cause, to timely file the CGAD required by this act shall be required, after notice and hearing, to pay a penalty of one hundred dollars ($100.00) for each day that the CGAD is not filed, to be recovered by the commissioner. The maximu…

Short title. This act shall be known and may be cited as the "Ensuring Transparency in Prior Authorization Act."

(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…

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…

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…

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…

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…

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…

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…

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.

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…

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…

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…

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…

(a) Definitions. As used in this chapter: (i) "Applicant" means a health care provider who submits an application to a health carrier to become credentialed as a participating health care provider in one (1) or more of the health carrier's provider networks; (ii) "Application" me…

requirements. Health care provider credentialing; (a) Within seven (7) calendar days after a health carrier receives an application for credentialing, the health carrier shall provide the applicant notice of receipt of the application in written or electronic form and contact inf…