HF3398 Summary

• Replaces terminology of "certification" with "authorization" and "determinations not to certify" with "adverse determinations" throughout utilization review regulations effective January 1, 2021.

• Reduces standard utilization review timeframes from 10 business days to 5 business days and expedited review from 72 hours to 48 hours, with expedited appeals requiring response within 72 hours.

• Reduces standard appeal decision timelines from 30 days to 15 days after receipt, with option for up to 4 additional days if circumstances prevent timely determination.

• Requires health plan companies to post prior authorization requirements and restrictions on public websites and provide 45 days' notice to providers before implementing new or amended requirements.

• Establishes new continuity of care provisions requiring compliance with prior authorizations from previous health plans for 60 days and protecting prior authorizations when clinical criteria change mid-year.