SB294 Summary

• Establishes the Alabama Utilization Review Modernization Act to set standards for health insurance prior authorization decisions, including 72-hour response timeframes for non-urgent requests and 24-hour timeframes for urgent requests, with automatic approval if deadlines are not met.

• Requires all prior authorization decisions and adverse determinations to be made by licensed physicians or health care professionals, not artificial intelligence alone, who must evaluate clinical circumstances and relevant medical necessity criteria.

• Mandates that insurers grant "gold card" status exempting physicians and health care professionals from prior authorization requirements for covered services when they demonstrate a 90 percent approval rate with at least seven patient cases in the prior year, beginning January 1, 2026.

• Requires insurers to provide detailed adverse determination notices to both providers and patients, establish accessible appeal processes, and complete appeal decisions within 72 hours for non-urgent requests and 24 hours for urgent requests, with appeals decided by different physicians.

• Becomes effective October 1, 2025, with gold card exemption provisions effective January 1, 2026.