AK HB187

Utilization review entities may not require prior authorization from health care providers with an 80 percent or higher approval rate on prior authorization requests over the previous 12 months.

Exemptions from prior authorization requirements remain in effect for 12 months and can be evaluated or revoked only once per year, with exemptions lasting until 30 days after revocation notice or 5 days after appeal denial.

Health care providers do not need to request an exemption to qualify and may appeal denials or revocations; determinations must be made by a licensed provider with the same or similar specialty and relevant experience.

Utilization review entities cannot deny or reduce payment for exempted health care services except for knowing misrepresentation or failure to substantially perform the service.

Prior authorizations for chronic or long-term care conditions are valid for the duration of treatment without requiring additional authorizations.