44-5437. Uniform prior authorization request forms; use; required, when.

288 words·~1 min read·/ne/chapter-44/44-5437

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(1)(a) On or before November 1, 2025, the department shall approve a single uniform prior authorization request form for prescription drugs, devices, and durable medical equipment and a single uniform prior authorization request form for all other health care services. The uniform prior authorization request forms shall not exceed two printed pages in length. This two-page limit does not apply to information or documentation required by the utilization review agent, as published in accordance with subsection

(1)of section 44-5434 , or a health care provider's notes or documentation submitted in support of a prior authorization request.

(b)Beginning January 1, 2026:

(i)All health care providers shall use only the approved uniform prior authorization request forms; and

(ii)Except as provided in subsection

(2)of this section, all utilization review agents shall accept and process prior authorization requests submitted using such forms.

(c)This subsection does not prohibit a utilization review agent from using a prior authorization methodology that uses an Internet webpage, an Internet webpage portal, or a similar web-based system if the methodology is consistent with the uniform prior authorization request forms approved by the department pursuant to this subsection.

(2)A utilization review agent may request from the department an exemption from the requirements of subsection

(1)of this section if the utilization review agent implements and maintains a prior authorization application programming interface pursuant to 45 C.F.R. 156.223(b) or other electronic prior authorization methodology that automates and standardizes the prior authorization process for patients, health care providers, and health carriers. A utilization review agent shall provide notice to health care providers at least ninety days prior to implementing a prior authorization application programming interface or other electronic prior authorization methodology under this subsection.