HB 1810 Summary

• Modifies definitions in the Ensuring Access to Medicaid Act, including "adverse determination," "urgent health care service," and adds new definitions like "prior authorization" and "medical necessity."

• Establishes time requirements for prior authorization decisions: 24 hours for hospitalized members and inpatient behavioral health services, 72 hours for non-hospitalized members, 72 hours for urgent services, and 7 days for non-urgent services.

• Requires contracted entities to implement a Prior Authorization Application Programming Interface (API) by January 1, 2027, and mandates participating providers have compatible electronic health records or practice management systems by July 1, 2027.

• Expands the Children's Specialty Plan to include additional eligible groups on and after July 1, 2026, including children in Family Centered Services cases, children in Department of Human Services custody, and Medicaid-enrolled parents and guardians of affected children.

• Deems requested health care services authorized if a provider submits all necessary information and the contracted entity fails to meet specified decision deadlines; prohibits prior authorization for emergency services and establishes peer-to-peer review opportunities within specified timeframes.

• Effective date: November 1, 2025.