FL S1434

Redefines "health insurer" as "utilization review entity" to include insurers, managed care plans, HMOs, pharmacy benefit managers, and other entities administering health benefits in Florida.

Requires utilization review entities to establish a secure, interactive online electronic prior authorization process by January 1, 2024, allowing documentation uploads for request adjudication.

Mandates that adverse determination decisions be made by Florida-licensed physicians in the same specialty as the treating physician, with experience treating the relevant medical condition.

Prohibits prior authorization requirements for emergency health care services, prehospital transportation, and FDA-approved medications for opioid use disorder.

Establishes strict timelines: 2 business days for nonurgent health care services and 1 business day for urgent services; requires public disclosure of all prior authorization criteria, approval/denial data, and 60-day notice before implementing changes.