CT HB06832

Commissioner shall develop and establish technical standards by January 1, 2024 for hospitals and health care professionals to electronically file prior authorization requests and prospective or concurrent utilization reviews with health carriers.

Commissioner shall develop standardized clinical review criteria by January 1, 2024 for common services, treatments, and procedures provided in hospitals in inpatient and outpatient settings, in consultation with hospitals, health care professionals, and health carriers.

Each health carrier must establish a secure electronic program by March 1, 2024 for filing prior authorization requests and submitting clinical information, as well as transmitting responses to such requests, complying with commissioner-established standards.

Health carriers must provide hospitals and health care professionals access to their criteria for making prior authorization determinations, including documentation requirements, and cannot use facsimiles, electronic forms, or proprietary portals that fail to comply with technical standards.

Health carriers must consult with hospitals before implementing technical or clinical standards to ensure seamless transmission and processing of requests, including regarding submission of clinical records and secure access to electronic health information.