CT SB00861

Commissioner of Insurance must develop uniform prior authorization forms by January 1, 2014, for health care services including office visits, prescription drugs, imaging, and diagnostic testing, with input from health carriers, utilization review companies, and health care professionals.

Prior authorization forms must not exceed two pages, be available in paper and electronic formats, be capable of electronic completion and submission, and align with Centers for Medicare and Medicaid Services standards and national electronic prior authorization procedures.

Health carriers and utilization review companies must use and accept the uniform forms within 180 days of notification; failure to accept a properly completed form or respond within 24 hours results in automatic approval of the prior authorization request.

Health carriers must make clinical review criteria electronically available to contracted health care professionals, and managed care organizations must post current medical protocols on their Internet websites for participating providers.

All provisions take effect October 1, 2013, amending sections 38a-591c and 38a-478e of Connecticut General Statutes.