MISSISSIPPI LEGISLATURE
2013 Regular Session
To: Insurance; Public Health and Human Services
By: Representative Howell
AN ACT TO DIRECT THE DEPARTMENT OF INSURANCE TO DEVELOP A UNIFORM PRIOR AUTHORIZATION FORM THAT MEETS CERTAIN CRITERIA; TO REQUIRE EVERY HEALTH INSURANCE ISSUER THAT PROVIDES PRESCRIPTION DRUG BENEFITS TO USE AND ACCEPT ONLY THE UNIFORM PRIOR AUTHORIZATION FORM DEVELOPED BY THE DEPARTMENT WHEN REQUIRING PRIOR AUTHORIZATION FOR COVERAGE OF PRESCRIPTION DRUG BENEFITS, AND REQUIRE EVERY HEALTH BENEFIT PLAN TO ACCEPT THE FORM AS SUFFICIENT TO REQUEST PRIOR AUTHORIZATION FOR PRESCRIPTION DRUG BENEFITS; TO PROVIDE THAT IF A HEALTH INSURANCE ISSUER FAILS TO USE OR ACCEPT THE UNIFORM PRIOR AUTHORIZATION FORM, OR FAILS TO RESPOND WITHIN TWO BUSINESS DAYS UPON RECEIPT OF A COMPLETED PRIOR AUTHORIZATION REQUEST FROM A PRESCRIBING PROVIDER, THE PRIOR AUTHORIZATION REQUEST WILL BE DEEMED TO HAVE BEEN GRANTED; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. (1) As used in this section:
(a) "Health benefit plan" means services consisting of medical care, provided directly, through insurance or reimbursement, or otherwise, and including items and services paid for as medical care under any hospital or medical service policy or certificate, hospital or medical service plan contract, preferred provider organization, or health maintenance organization contract offered by a health insurance issuer.
(b) "Health insurance issuer" means any entity that offers health insurance coverage through a health benefit plan, policy, or certificate of insurance subject to state law that regulates the business of insurance. "Health insurance issuer" also includes a health maintenance organization, as defined and regulated under Section 83-41-301 et seq.
(c) "Prior authorization" means a utilization management criterion used to seek permission or waiver of a drug to be covered under a health benefit plan that provides prescription drug benefits.
(2) On and after January 1, 2014, every health insurance issuer that provides prescription drug benefits shall use and accept only the uniform prior authorization form developed under subsection (4) of this section when requiring prior authorization for coverage of prescription drug benefits, and every health benefit plan shall accept the uniform prior authorization form as sufficient to request prior authorization for prescription drug benefits.
(3) If a health insurance issuer fails to use or accept the uniform prior authorization form, or fails to respond within two (2) business days upon receipt of a completed prior authorization request from a prescribing provider, with the submission of the uniform prior authorization form developed under subsection (4) of this section, the prior authorization request shall be deemed to have been granted.
(4) The Department of Insurance shall develop a uniform prior authorization form, which shall meet the following criteria:
(a) The form shall not exceed two (2) pages.
(b) The form shall be made available electronically by the Department of Insurance and the health benefit plan.
(c) The completed form also may be submitted electronically from the prescribing provider to the health benefit plan.
(d) The Department of Insurance shall develop the form with input from interested parties received at one or more public meetings.
(e) The Department of Insurance, in developing the standardized form, shall take into consideration the following:
(i) Existing prior authorization forms established by the federal Centers for Medicare and Medicaid Services and the Division of Medicaid.
(ii) National standards, or draft standards, pertaining to electronic prior authorization.
SECTION 2. This act shall take effect and be in force from and after July 1, 2013.