Senate Bill 2622 Summary

• Establishes the Mississippi Prior Authorization Reform Act requiring health insurance issuers to maintain complete lists of services requiring prior authorization and post clinical review criteria and requirements on their websites in accessible, understandable language.

• Requires health insurance issuers to provide standardized electronic prior authorization request processes by January 1, 2024, with mandatory use by all health care professionals and providers by January 1, 2026.

• Sets response deadlines of two (2) working days for nonurgent prior authorization requests and twenty-four (24) hours for urgent health care services, with automatic approval if insurers fail to meet deadlines.

• Requires adverse determinations and appeals be reviewed by physicians licensed in any U.S. jurisdiction with relevant specialty experience; prohibits revocation of previously approved prior authorizations while valid; and establishes valid approval periods of six (6) months for standard services and twelve (12) months for chronic conditions.

• Authorizes the Department of Health to enforce provisions through cease-and-desist orders and administrative fines up to $10,000 per violation; requires insurers to report prior authorization statistics and denial data annually; and requires reporting of suspected fraudulent prior authorization requests to the Commissioner of Insurance.