SB 3 IN

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Provides that a utilization review entity may only impose prior authorization requirements on less than 1% of any given specialty or health care service and 1% of health care providers overall in a calendar year. Prohibits a utilization review entity from requiring prior authorization for: (1) a health care service that is part of the usual and customary standard of care; (2) a prescription drug that is approved by the federal Food and Drug Administration; (3) medication for opioid use disorder; (4) pre-hospital transportation; or (5) the provision of an emergency health care service. Sets forth requirements for a utilization review entity that requires prior authorization of a health care service. Provides that all adverse determinations and appeals must be reviewed by a physician who meets certain conditions. Requires a utilization review entity to provide an exemption from prior authorization requirements if in the most recent 12 month period the utilization review entity has approved or would have approved at least 80% of the prior authorization requests submitted by the health care provider for a particular health care service. Repeals superseded provisions regarding prior authorization. Makes corresponding changes.

• Tyler Johnson Republican · author
• Ed Charbonneau Republican · author
• Chris Garten Republican · author

1. Jan 16, 2024 Authored by Senator Johnson T · upper
2. Jan 16, 2024 First reading: referred to Committee on Health and Provider Services · upper
3. Jan 16, 2024 Senator Charbonneau added as second author · upper
4. Jan 16, 2024 Senator Garten added as third author · upper
5. Jan 16, 2024 Senators Brown L and Rogers added as coauthors · upper
6. Jan 16, 2024 Senators Baldwin and Messmer added as coauthors · upper
7. Jan 16, 2024 Senator Becker added as coauthor · upper
8. Jan 16, 2024 Senator Crider added as coauthor · upper
9. Jan 16, 2024 Senator Bohacek added as coauthor · upper
10. Jan 16, 2024 Senators Busch and Koch added as coauthors · upper
11. Jan 16, 2024 Senator Leising added as coauthor · upper
12. Jan 16, 2024 Senators Walker K and Alexander added as coauthors · upper
13. Jan 18, 2024 Pursuant to Senate Rule 68(b); reassigned to Committee on Appropriations · upper
14. Jan 18, 2024 Senator Yoder added as coauthor · upper
15. Jan 18, 2024 Senator Ford J.D. added as coauthor · upper
16. Jan 18, 2024 Senator Donato added as coauthor · upper
17. Jan 18, 2024 Senators Alting and Doriot added as coauthors · upper
18. Jan 18, 2024 Committee report: do pass, adopted · upper
19. Jan 22, 2024 Senators Buck and Zay added as coauthors · upper
20. Jan 22, 2024 Senator Niezgodski added as coauthor · upper
21. Jan 25, 2024 Senator Randolph added as coauthor · upper