AK SB219

Exempts health care providers from prior authorization requirements if a utilization review entity has approved or would have approved at least 80 percent of their prior authorization requests during the most recent 12-month period.

Allows utilization review entities to evaluate exemptions no more than once every 12 months and permits revocation after 12 months if retrospective review shows the provider no longer meets the 80 percent approval threshold based on previous three months of claims or minimum of 10 claims.

Requires exemption determinations be made by a licensed health care provider with the same or similar specialty as the provider being considered, and mandates utilization review entities provide written notice of exemptions including duration and applicable services.

Prohibits denial or reduction of payment for exempted services unless the provider knowingly misrepresented the service with intent to deceive or failed to substantially perform the service.

Allows providers to request evidence supporting denial of an exemption once every 12 months and provides appeal rights for both denial and revocation determinations; takes effect immediately.