NJ A540

Requires utilization review entities to post all prior authorization requirements, clinical criteria, and approval/denial statistics on their websites, with 60-day advance written notice to providers before implementing new or amended requirements

Mandates that all adverse prior authorization determinations and appeals be reviewed by New Jersey-licensed physicians in the same specialty as the treating provider, with enrollees' physicians given opportunity to discuss medical necessity before denials

Establishes strict timelines: one calendar day for standard prior authorization decisions, 24 hours for urgent services, and 60 minutes for post-emergency stabilization services, with automatic approval if deadlines are missed

Prohibits prior authorization for emergency services, pre-hospital transportation, opioid use disorder medications prescribed in emergencies, generic non-controlled medications, and drugs after six months of adherence; eliminates mandatory step therapy protocols at provider discretion

Prior authorizations remain valid for one year, cannot be revoked if care is provided within 45 business days, and must be honored for 60 days when enrollees change health plans; applies to commercial insurers, HMOs, and state employee health programs