Bill Summary: HB 06586 - Prior Authorizations and Health Care Provider Contracts

• Requires health carriers to reimburse facilities and health care professionals for medically necessary covered benefits and establishes a reconsideration process for denied coverage claims within 18 months of denial.

• Prohibits health carriers from requiring prior authorization for certain services (surgeries during perioperative periods, nursing home discharges after hospitalization) and mandates one-hour response times for post-stabilization and maintenance service authorization requests, with carriers financially liable if they fail to respond timely.

• Mandates health carriers entering into participating provider contracts provide at least 90 days' advance written notice of changes to contract provisions, documents, provider manuals, or policies, with providers having the right to appeal proposed changes.

• Requires health carriers to submit annual prior authorization reports to the Insurance Commissioner detailing approval rates, denial rates, appeal outcomes, and response times, with reports made publicly available.

• Establishes new regulatory standards including standardized prior authorization appeal procedures, technical standards for electronic filing, standardized clinical review criteria, and requires the Insurance Commissioner to conduct annual health care provider satisfaction surveys.