HB 775 - Mississippi Prior Authorization Reform Act

• Requires health insurance issuers to maintain and publicly post complete lists of services requiring prior authorization with clinical review criteria based on nationally recognized standards, updated at least annually.

• Mandates standardized electronic prior authorization systems available by January 1, 2025, with mandatory provider use by January 1, 2027, and establishes response timeframes of 5 calendar days for standard requests and 24 hours for urgent requests.

• Prohibits insurers from denying claims for failure to obtain prior authorization if the requirement was not in effect on the date of service, and prevents revocation of previously issued approvals while valid.

• Establishes that prior authorization approvals remain valid for 6 months (or 12 months for chronic conditions) and requires new insurers to honor prior authorizations from previous insurers for at least 90 days of coverage.

• Requires physicians making adverse determinations to be board-certified in relevant specialties, mandates appeal reviewers be different physicians also board-certified, and subjects non-compliant insurers to automatic authorization of disputed services and fines up to $10,000 per violation.