62M.18 ANNUAL POSTING ON WEBSITE; PRIOR AUTHORIZATIONS.

184 words·~1 min read·/mn/chapter-62/62m-18

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

(a)By April 1, 2022, and each April 1 thereafter, a health plan company must post on the health plan company's public website the following data for the immediately preceding calendar year for each commercial product:

(1)the number of prior authorization requests for which an authorization was issued;

(2)the number of prior authorization requests for which an adverse determination was issued and sorted by:

(i)health care service;

(ii)whether the adverse determination was appealed; and

(iii)whether the adverse determination was upheld or reversed on appeal;

(3)the number of prior authorization requests that were submitted electronically and not by facsimile or email or other method pursuant to section 62J.497 ; and

(4)the reasons for prior authorization denial including but not limited to:

(i)patient did not meet prior authorization criteria;

(ii)incomplete information submitted by the provider to the utilization review organization;

(iii)change in treatment program; and

(iv)the patient is no longer covered by the plan.

(b)All information posted under this section must be written in easily understandable language.