HB1271 Summary

• Healthcare providers receiving 90% or more approval on prior authorization requests between January 1, 2022 and June 30, 2022 qualify for exemption from prior authorization requirements effective January 1, 2024 through September 30, 2024.

• Healthcare insurers must evaluate exemptions every 12 months using retrospective review of random samples (5-20 claims) and may only rescind exemptions if approval rate falls below 90%, with 25 days advance notice and detailed explanation provided to providers.

• Providers have the right to independent review of exemption rescissions within 12 months and insurers must pay for appeals; if 50% of appeals are overturned in a 12-month period, the Insurance Commissioner may refuse to renew the insurer's license.

• Prescription drugs and pharmaceuticals are exempt from these requirements until December 31, 2024; after January 1, 2025, the Arkansas State Board of Pharmacy and State Medical Board jointly review requests for continued prior authorization of medications.

• Establishes new discussion requirements for adverse prior authorization determinations, allowing providers to contact reviewing physicians within 1-2 business days to discuss treatment plans before final denial.