§ 23-99-1304. Enforcement
(a) A contracting entity is subject to the Trade Practices Act, § 23-66-201 et seq. (b) The State Insurance Department shall enforce this subchapter.
§ 23-99-1117. Standardized form required for prescription drug benefits
(a) On and after January 1, 2017, to establish uniformity in the submission of prior authorization forms for prescription drugs, a utilization review entity shall utilize only a single standardized prior authorization form for obtaining approval in written or electronic form for prescription drug benefits. (b) A utilization review entity may make the form required […]
§ 23-99-1305. Rules
(a) The Insurance Commissioner shall promulgate rules necessary to ensure compliance with this subchapter. (b) (1) When adopting the initial rules to ensure compliance with this subchapter, the final rule shall be filed with the Secretary of State for adoption under § 25-15-204(f): (A) On or before March 1, 2020; or (B) If approval under […]
§ 23-99-1118. Rules
The State Insurance Department may promulgate rules for the implementation of this subchapter.
§ 23-99-1119. Medication-assisted treatment for opioid addiction
(a) Except in the case of injectables, a healthcare insurer, including Medicaid, shall not: (1) Require prior authorization in order for a patient to obtain coverage of buprenorphine, naloxone, naltrexone, methadone, and their various formulations and combinations approved by the United States Food and Drug Administration for the treatment of opioid addiction; or (2) Impose […]
§ 23-99-1201. Title
This subchapter shall be known and may be cited as the “Healthcare Contracting Simplification Act”.
§ 23-99-1202. Definitions
As used in this subchapter: (1) “All-products clause” means a provision in a healthcare contract that requires a healthcare provider, as a condition of participation or continuation in a provider network or a health benefit plan, to: (A) Serve in another provider network utilized by the contracting entity or a healthcare insurer affiliated with the […]
§ 23-99-1106. Prior authorization — Urgent healthcare service
A utilization review entity shall render an expedited authorization or adverse determination concerning an urgent healthcare service and notify the subscriber and the subscriber’s healthcare provider of that expedited prior authorization or adverse determination no later than one (1) business day after receiving all information needed to complete the review of the requested urgent healthcare […]
§ 23-99-1107. Prior authorization — Emergency healthcare service
(a) A utilization review entity shall not require prior authorization for prehospital transportation or for provision of an emergency healthcare service. (b) (1) A utilization review entity shall allow a subscriber and the subscriber’s healthcare provider a minimum of twenty-four (24) hours following an emergency admission or provision of an emergency healthcare service for the […]
§ 23-99-1108. Subscribers with terminal illness — Denial of prior authorization for covered prescription pain medication prohibited
If a subscriber’s covered prescription pain medication requires a prior authorization, then the prior authorization shall not be denied if the subscriber has a terminal illness.