MS HB866

Exempts physicians and healthcare providers from preauthorization requirements for specific services when the insurer has approved at least 90% of their preauthorization requests for that service during the most recent six-month evaluation period

Health insurers must evaluate provider eligibility for exemption every six months and notify providers within five days of qualifying, listing covered services and exemption duration

Insurers may only rescind an exemption during January or June if a retrospective review of 5-20 random claims shows less than 90% met medical necessity criteria, with rescission determinations made by a physician licensed in Mississippi with the same or similar specialty

Providers may appeal exemption denials or rescissions to an independent review organization at the insurer's expense, with decisions due within 30 days; insurers cannot require internal appeals before independent review

Applies to health benefit plans including those contracting with Medicaid (but not Medicaid itself), HMOs, and managed care organizations, effective for preauthorization requests made on or after January 1, 2023