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Title 26 Insurance Code

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Change 1

What to do with it
As published

26-55-110. Length of authorization generally; revocation

of prior authorizations prohibited; length of authorization for chronic or long-term care conditions. (a) Each authorization shall have the following timelines: (i) Outpatient service prior authorizations shall be valid for a period of not less than one (1) year; (ii) Prescription drug authorization periods shall be effective for a period of not less than one (1) year including changes in dosage for a prescription drug prescribed by a health care provider, provided that the authorization period and dosage change are consistent with dosing and duration according to evidence-based guidelines for safety and efficacy; (iii) Prior authorizations for inpatient services shall be valid for a length of time based on the patient's clinical condition. This period will be not less than one (1) day. (b) Each health insurer or contracted utilization review entity shall not revoke, limit, condition or restrict a previously approved authorization for health care services if the health care services are provided within forty-five (45) business days from the date the health care provider received the authorization approval for the specific service that was authorized. (c) If a health insurer or contracted utilization review entity requires a prior authorization request for a health care service for the treatment of a chronic or long-term care condition, the authorization shall remain valid for one (1) year. This section shall not apply to the prescription of benzodiazepines or schedule II narcotic drugs.

Your change, as a redline

26-55-110. Length of authorization generally; revocation

of prior authorizations prohibited; length of authorization for chronic or long-term care conditions. (a) Each authorization shall have the following timelines: (i) Outpatient service prior authorizations shall be valid for a period of not less than one (1) year; (ii) Prescription drug authorization periods shall be effective for a period of not less than one (1) year including changes in dosage for a prescription drug prescribed by a health care provider, provided that the authorization period and dosage change are consistent with dosing and duration according to evidence-based guidelines for safety and efficacy; (iii) Prior authorizations for inpatient services shall be valid for a length of time based on the patient's clinical condition. This period will be not less than one (1) day. (b) Each health insurer or contracted utilization review entity shall not revoke, limit, condition or restrict a previously approved authorization for health care services if the health care services are provided within forty-five (45) business days from the date the health care provider received the authorization approval for the specific service that was authorized. (c) If a health insurer or contracted utilization review entity requires a prior authorization request for a health care service for the treatment of a chronic or long-term care condition, the authorization shall remain valid for one (1) year. This section shall not apply to the prescription of benzodiazepines or schedule II narcotic drugs.

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