Health Insurance State Laws:
Prior Authorizations

This chart highlights the state laws related to prior authorizations, including if the state has a consumer protection law, if there is pending legislation, and more. Check back often, as this chart is updated frequently.

If you have a self-funded plan, certain state laws may not apply. For information on how to determine if your plan is self-funded, see our blog post.

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StateState Law Consumer Protection on Prior AuthorizationsBrief Description of the State Law ProtectionPending LegislationBrief Description of the Pending Legislation
ALABAMAHealth Care Service Utilization Review Act (1994) (Codified at Alabama Code 1975 § 27-3A-5)https://www.alabamapublichealth.gov/mcc/assets/urlaw.pdfDetermination required within two business days of receipt of request and documentation; appeal determinations must be issued by a physician in the same or similar specialty within thirty days; expediated appeal over the telephone by patient's attending physician available for future or ongoing authorization requests; insurer must allow twenty-four hours for authorization requests after emergency admissions or procedures.
ALASKAAlaska Statutes § 21.07.020 – Required Contract Provisions for Health Care Insurance PolicyProhibits retroactive denial of preauthorization unless preauthorization is based on materially incomplete or inaccurate information.
ARIZONAArizona Revised Statutes: § 20-3403 – Prior Authorization Requirements; § 20-3404 – Prior Authorization Requirement Timelines; § 20-3405 – Prior Authorization of Prescription Drugs for Chronic Pain Conditions; § 20-2534 – Expedited Medical Reviewhttps://www.azleg.gov/arsDetail/?title=20Requires availability of universal electronic prior authorization request forms; determination required within five days for urgent requests and fourteen days for all other requests; prohibits retroactive denial of preauthorization unless there was fraud or misrepresentation; prior authorization for prescription drugs for chronic pain must last at least six months; provides for expedited medical review within one business day for denials that are likely to cause a significant negative change in the patient's condition.
ARKANSASPrior Authorization Transparency Acts (2017 and 2015) (Codified at Arkansas Code §§ 23-99-1101 to -1119)https://advance.lexis.com/documentpage/?pdmfid=1000516&crid=96a774e0-4523-48c7-8d73-b3196f3476a2&nodeid=AAXAADABPAAMAAC&nodepath=/ROOT/AAX/AAXAAD/AAXAADABP/AAXAADABPAAM/AAXAADABPAAMAAC&level=5&haschildren=&populated=false&title=23-99-1101.%20Title.&config=00JAA2ZjZiM2VhNS0wNTVlLTQ3NzUtYjQzYy0yYWZmODJiODRmMDYKAFBvZENhdGFsb2fXiYCnsel0plIgqpYkw9PK&pddocfullpath=/shared/document/statutes-legislation/urn:contentItem:5G62-8RX0-R03K-913W-00008-00&ecomp=_g1_kkk&prid=2de153e7-f6bf-4d00-afcb-5780e65decb3Determination required within two business days of receipt for nonurgent prior authorization requests and one business day for urgent requests; determination required within seventy-two hours for prescription drug requests; prohibits denials of prior authorization for certain prescription pain medications if patient has a terminal illness; prohibits withdrawl of authorization for lack of medical necessity unless notification is provided three business days before the scheduled service; prior authorization must remain valid for at least ninety days.
CALIFORNIAHealth and Safety Code §§ 1374.30 to .36 – Appeals Seeking Independent Medical Reviews; 2021 Assembly Bill 347 (to be codified at Health and Safety Code §§ 1367.206, 1367.241); Health and Safety Code § 1367.665 – Cancer screening tests; prior authorization for biomarker testing.https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202120220AB347Patient may appeal prior authorization denials to state Independent Medical Review program if denial was for medical necessity or experimental nature of the treatment, or for an emergency/urgent treatment; requires automatic approval of prior authorization requests for prescription drugs within seventy-two hours for nonurgent requests and twenty-four hours if there are exigent circumstances; requires insurers to submit to binding external appeals process after denial of prior authorization requests; insurer cannot require prior authorization for biomarker testing for patients with advanced or metastatic stage 3 or 4 cancer.
COLORADOColorado Revised Statutes: § 10-16-112.5 – Prior Authorization, § 10-16-113 – Procedures for Denial of Benefits, § 10-16-113.5 – Independent External Review, § 10-16-124.5 – Prior Authorization Drug Benefitshttps://advance.lexis.com/documentpage/?pdmfid=1000516&crid=8df6e399-a9a3-478e-a62d-3639e23fcbcc&nodeid=AAKAARAABAAB&nodepath=%2FROOT%2FAAK%2FAAKAAR%2FAAKAARAAB%2FAAKAARAABAAB&level=4&haschildren=&populated=false&title=Article+16+Health+Care+Coverage&config=014FJAAyNGJkY2Y4Zi1mNjgyLTRkN2YtYmE4OS03NTYzNzYzOTg0OGEKAFBvZENhdGFsb2d592qv2Kywlf8caKqYROP5&pddocfullpath=%2Fshared%2Fdocument%2Fstatutes-legislation%2Furn%3AcontentItem%3A61P5-WPR1-DYDC-J54G-00008-00&ecomp=_g1_9kk&prid=927d3974-436d-4c64-a0e2-00c24efd6732Insurer must make prior authorization requirements and restrictions, including written clinical criteria, accessible on website; requires determination for medical service requests within five business days for nonurgent requests, within two business days for urgent requests; requires prior authorizations to remain valid for at least 180 days; prohibits retroactive denials of prior authorization except for fraud or misrepresentation; requires two levels of internal review with involvement of physician and clinical peer along with option to seek independent external review; requires insurer to allow patient to be present at second level internal review; requires determination for prescription requests within 3 business days for nonurgent requests and one business day for urgent requests.
CONNECTICUTConnecticut General Statutes § 38a-472g – Restrictions Applicable to Prior Authorization, § 38a-492l – Mandatory Coverage for Neuropsychological Testing for Children Diagnosed with Cancer, § 38-591l – Independent Reviewhttps://www.cga.ct.gov/current/pub/title_38a.htmProhibits recission of prior authorization unless notice is provided at least three business days before the scheduled treatment; prohibits insurers from requiring prior authorization for neuropsychological testing to assess the extent of any cognitive delays in children diagnosed with cancer; provides for external review of final prior authorization denials by independent review organizations.
DELAWARE2016 House Bill 381 (Codified at Delaware Code Title 18, Chapter 33, Subchapter II – Pre-Authorization Transparency §§ 3371–3381)https://delcode.delaware.gov/title18/c033/sc02/index.htmlRequires insurers to make pre-authorization requirements, restrictions, and clinical criteria accessible on their website; requires determination within two business days for nonurgent pharmaceuticals and eight business days for nonurgent health-care services; prohibits retroactive denial of preauthorization based on medical necessity (when a prudent physician would provide the service to the patient in accordance with the generally accepted standards of practice, consistent with the treatment of the conditions, not for convenience); requires preauthorization to be valid for at least one year for pharmaceuticals and sixty days for health-care services.
*DISTRICT OF COLUMBIA
FLORIDAFlorida Statutes § 627.42392 – Prior Authorization, § 627.4239 – Coverage of Cancer Treatment Drugshttp://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0600-0699/0627/0627PartIIContentsIndex.html&StatuteYear=2021&Title=%2D%3E2021%2D%3EChapter%20627%2D%3EPart%20IIRequires use of standardized approved prior authorization form that contains all clinical documentation necessary for insurer to make decision; prohibits insurers from denying coverage for any cancer drug on the grounds that it is not approved by FDA for a particular indication when such drug is recognized for treatment in a standard reference compendium or recommended in medical literature.
GEORGIAEnsuring Transparency in Prior Authorization Act (2021) (Codified at Georgia Code §§ 33-46-20 to -32)http://www.lexisnexis.com/hottopics/gacode/default.aspRequires insurers to make prior authorization requirements and restrictions, including written clinical criteria in readily understandable language, readily accessible on their website; requires insurers to make all adverse decisions by a physician who is in the same specialty that typically treats the patient's condition and who has experience with the patient's condition; limits insurers from revoking or restricting prior authorization if health care services are performed within forty-five business days of approval; prohibits insurers from requiring prior authorization for emergency/urgent health care services or covered health care services incidental to the primary covered health care service; requires determination within seventy-two hours for urgent health care services.
HAWAII
IDAHOIdaho Code § 41-3930 – Utilization Management Program Requirements, § 41-1846 – Health Care Policies Requirements, Idaho Health Carrier External Review Act (2011) (Codified at Idaho Code §§ 41-5901 to –5917),https:/legislature.idaho.gov/statutesrules/idstat/title41/t41ch39/sect41-3930/Prohibits insurers from requiring prior authorization for emergency services; requires determination within two business days for nonurgent requests; prohibits insurers from rescinding prior authorization after service is provided except for fraud, misrepresentation, or non-payment of premium; requires insurers to submit to external review for denial of prior authorization or coverage after exhaustion of internal appeals.
ILLINOISPrior Authorization Reform Act (2021) (Codified at 215 ILCS 200), Health Carrier External Review Act (2010) (Codified at 215 ILCS 180), Managed Care Reform and Patients Rights Act (2000) (Codified at 215 ILCS 134)https://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=4201&ChapterID=22Requires insurers to make prior authorization requirements, restrictions, and clinical criteria readily accessible on their website; requires determination within five calendar days for nonurgent requests and forty-eight hours for urgent requests; requires prior authorization to remain valid for the lesser of at least six months or the length of the treatment; requires prior authorization to remain valid for the lesser of at least twelve months or the length of the treatment for the treatment of chronic or long-term conditions; requires insurers to submit to external review for denial of prior authorization or coverage.
INDIANAIndiana Code Title 27 Chapter 37.5 Health Care Service Prior Authorizationhttp://iga.in.gov/legislative/laws/2021/ic/titles/027#27-1-37.5Requires insurers to make the specific information required for prior authorization along with CPT codes for which prior authorization is required for available on their website; requires determination within seventy-two hours for urgent requests and within seven days for nonurgent requests; prohibits insurers from retroactively denying prior authorization except for fraud or misrepresentation of material information.2022 House Bill 1271http://iga.in.gov/legislative/2022/bills/house/1271#document-a343b734Proposing to require insurers to allow a clinical peer to peer conversation between the patient's provider and insurer's provider after denial of prior authorization requests, waiver of prior authorization requirements for providers that meet criteria, providing for independent external review
IOWAIowa Administrative Code Chapter 79.8 - Requests for Prior Authorizationhttps://www.legis.iowa.gov/docs/iac/rule/441.79.8.pdfRequires determination within seventy two hours for urgent prescription drug requests and within five calendar days for nonurgent prescription drug requests; requires insurers to make prior authorization requirements for prescription drugs available on their website.
KANSASKansas Statutes § 40-3229 – Prior Authorization Requirements for Emergency Medical Treatmentshttp://www.kslegislature.org/li/b2021_22/statute/040_000_0000_chapter/040_032_0000_article/040_032_0029_section/040_032_0029_k/Prohibits insurers from denying emergency medical services based on a lack of prior authorization.
KENTUCKYKentucky Senate Bill 54 (2019) (Codified at Kentucky Revised Statutes Chapter 304 Subtitle 17A Utilization Reviews §§ 600–633), Kentucky Revised Statutes Chapter 304 Subtitle 17A Miscellaneous Provisions § 163https://apps.legislature.ky.gov/law/statutes/chapter.aspx?id=38715Requires insurers to make prior authorization requirements (including covered CPT codes and the procedure used to make determinations) available on their website; requires determination within twenty-four hours for urgent requests and within five days for nonurgent requests; requires
LOUISIANA
MAINEMaine Revised Statutes Title 24-A § 4304 – Utilization Review, §4312 – Independent External Reviewhttps://legislature.maine.gov/statutes/24-A/title24-Asec4304.htmlRequires insurers to make determinations within the lesser of seventy-two hours or two business days for nonemergency requests; prohibits revocation of prior authorization unless there was fraud or materially incorrect information was provided; insurers must provide patients with a right to an independent external review of all adverse coverage decisions when the patient has exhausted the internal appeals process.
MARYLANDMaryland Code, Health - General § 19.108.2 – Benchmarks for Standardizing and Automating Process for Preauthorizing Health Care Services, Maryland Code, Insurance § 15-854 – Prior Authorization for Prescription Drugshttps://mgaleg.maryland.gov/mgawebsite/laws/statutesRequires insurers to accept electronic requests for pharmaceuticals and provide real time determinations for certain common prescriptions, determinations within one business day for nonurgent drugs, and determinations within two business days for nonurgent services; requires insurers to provide key criteria for making determinations; requires insurers to provide prior authorization for at least one year or the course of treatment for drugs used to treat chronic conditions.
MASSACHUSETTSMassachusetts General Laws 176O Health Insurance Consumer Protections § 25 – Use and Acceptance of Specifically Designated Prior Authorization Formshttps://malegislature.gov/Laws/GeneralLaws/PartI/TitleXXII/Chapter176O/Section25Requires determination within two business days for requests.2021 Senate Bill 637https://malegislature.gov/Bills/192/S637Proposing to require insurers to publish their prior authorization requirements, limiting ability to retroactively deny prior authorization unless it was obtained because of materially inaccurate information
MICHIGANPatient's Right to Independent Review Act (2000) (Codified at Michigan Compiled Laws §§ 550.1901 to .1929), Michigan Compiled Laws § 500.2212c – Standard Prior Authorization Methodology for Prescription Drugshttp://www.legislature.mi.gov/(S(5w4fo155xdycpr453nkf5s2h))/documents/mcl/pdf/mcl-Act-251-of-2000.pdfRequires insurers to submit to independent external review of coverage determination; requires determination within fifteen business days for nonurgent prescription drug requests and within seventy-two hours for expedited prescription drug requests.2021 Senate Bill 0247http://www.legislature.mi.gov/(S(muaz4rps0a31kf0l1hktfqp2))/mileg.aspx?page=GetObject&objectName=2021-SB-0247Proposing reduced timeline for determinations of seven calendar days for nonurgent requests and seventy-two hours for urgent reuqest, requiring insurers to publish prior authorization criteria online, requiring insurers to permit clinical peer to peer review requets, minimum durations for prior authorization validity of at least sixty calendar days
MINNESOTAMinnesota Statutes Chapter 62M Utilization Review of Health Care §§ 62m.01 to .18https://www.revisor.mn.gov/statutes/cite/62MRequires determination within five business days for nonurgent requests and within forty-eight hours with a minimum of one business day for urgent requests; prohibits retroactive revocation or limitations on prior authorization except for fraud or misinformation; insurer must provide provider or patient with determination criteria upon request; requires appeals of adverse prior authorization requests to be reviewed by a clinical peer of the patient's requesting provider.
MISSISSIPPIMississippi Code § 83-9-6-3 – Use of Standardized Prior Authorization Formhttps://advance.lexis.com/documentpage/?pdmfid=1000516&crid=ce74f58c-f959-4cd1-85bb-adb0f588db53&nodeid=ABRAAHAABAAI&nodepath=/ROOT/ABR/ABRAAH/ABRAAHAAB/ABRAAHAABAAI&level=4&haschildren=&populated=false&title=%c2%a7%2083-9-6.3.%20Standardized%20prior%20authorization%20form%20for%20obtaining%20prior%20authorization%20for%20prescription%20drug%20benefits.&config=00JABhZDIzMTViZS04NjcxLTQ1MDItOTllOS03MDg0ZTQxYzU4ZTQKAFBvZENhdGFsb2f8inKxYiqNVSihJeNKRlUp&pddocfullpath=/shared/document/statutes-legislation/urn:contentItem:8P6B-88V2-8T6X-72HC-00008-00&ecomp=_g1_kkk&prid=bdade22e-8b18-4326-b9f4-a38f321e3cb8Requires determination within two business days of receipt for prescription drugs.
MISSOURIRevised Statutes of Missouri §§ 376.1350, –.1389 Health Care Utilization Reviewhttps://revisor.mo.gov/main/OneSection.aspx?section=376.1350&bid=47950Requires determination within two business days of request and within one working day for concurrent review requests; provides for independent external review of adverse coverage determinations after two levels of internal appeals.
MONTANA2019 Montana House Bill 555 (Codified at Montana Code §§ 33-32-101, -102, -211, -212, -215).https://leg.mt.gov/bills/mca/title_0330/chapter_0320/parts_index.htmlRequires determination within seven business days for nonurgent requests and within twenty-four hours for urgent requests; insurers must make clinical review criteria and standards for prior authorization available on their website; prior authorizations must remain valid for at least three months.
NEBRASKA
NEVADANevada Revised Statutes 695G.150 Authorization of Recommended and Covered Health Care Services, § 695G.241 External Review of Adverse Determination.https://www.leg.state.nv.us/NRS/NRS-695G.htmlRequires insurers to establish and provide written criteria for prior authorization determinations; requires insurers to submit an an external review of adverse coverage decisions if the patient has exhausted all internal appeals.
NEW HAMPSHIRENew Hampshire Revised Statutes § 420-J:6 – Utilization Review, § 420-J:7-b – Prescription Drugs, § 420-J:5 Grievance Procedures, § 420-J:5-a Right to External Review.https://www.gencourt.state.nh.us/rsa/html/NHTOC/NHTOC-XXXVII-420-J.htmRequires determination within seventy-two hours for urgent medical requests and within fifteen business days for nonurgent medical requests; requires determination within forty-eight hours for prescription drug requests; requires insurers to have a clinical peer review appeals of adverse coverage determinations; requires insurers to submit to an independent external review for adverse coverage determinations when the patient has exhausted the normal internal appeals process or the patient has not received a determination within the required time frames.
NEW JERSEYNew Jersey Statutes 26:2S-11 Health Care Appeals Programhttps://lis.njleg.state.nj.us/nxt/gateway.dll?f=templates&fn=default.htm&vid=Publish:10.1048/EnuRequires insurers to submit to independent external review of coverage determinations by state appeals board.2022 Bill A1255 - Ensuring Transparency in Prior Authorization Act, 2022 Bill S202 - New Jersey Respect for Physicians Acthttps://www.njleg.state.nj.us/bill-searchEnsuring Transparency in Prior Authorization Act - requiring insurers to publish prior authorization requirements and restrictions, including written clinical criteria, on their website; requiring determinations within two business days for nonurgent requests and one business day for urgent requests; New Jersey Respect for Physicians Act - requiring insurers to respond with determinations within forty-eight hours for requests for prior authorization of health care services
NEW MEXICOPrior Authorization Act (2019) (Codified at New Mexico Statutes § 59A-22B-5 – Prior Authorization Requirements)https://nmonesource.com/nmos/nmsa/en/item/4438/index.do#!fragment/zoupio-_Toc91758942/BQCwhgziBcwMYgK4DsDWszIQewE4BUBTADwBdoAvbRABwEtsBaAfX2zgE4BGAdgFYAHBwAsAJgCUAGmTZShCAEVEhXAE9oAcg2SIhMLgRKV6rTr0GQAZTykAQuoBKAUQAyTgGoBBAHIBhJ5KkYABG0KTs4uJAARequires insurers to make determinations within twenty-four hours for medically urgent requests and within seven days within for all other requests; requires denials based on medical necessity to be reviewed by a health care professional with knowledge or who consults with a specialist who has knowledge of the condition or disease of the patient; provides for expedited independent external review of denied appeals to the insurer.
NEW YORKNew York Insurance Law § 3238 – Pre-Authorization of Health Care Services, New York Public Health Law § 4902 – Utilization Review Program Standards, New York Public Health Law § 4903 – Utilization Review Determinations, New York Public Health Law § 4910 - Right to External Review.https://www.nysenate.gov/legislation/laws/ISC/3238Requires determination within three business days of receipt of complete request and information; requires insurers to publish policies, procedures, and clinical review criteria for patients and health care providers; requires insurers to make determinations regarding appeals of adverse determinations within one business day of receipt; requires insurers to submit to external independent review of adverse coverage determinations.
NORTH CAROLINANorth Carolina General Statutes: § 58-50-61 – Utilization Review, § 58-50-62 – Insurer Grievance Procedures, § 58-50-80 Standard External Review, § 58-3-191 – Managed Care Reporting and Disclosure Requirements, § 58-3-200 Miscellaneous Insurance and Managed Care Coverage Provisionshttps://www.ncleg.gov/EnactedLegislation/Statutes/HTML/BySection/Chapter_58/GS_58-50-61.https:/www.ncleg.gov/EnactedLegislation/Statutes/HTML/BySection/Chapter_58/GS_58-50-61Requires determination within three business days of receipt of information; prohibits insurers from retroactively denying authorization except if authorization was based on known material misrepresentation; provides for independent external review of adverse coverage decisions by state review board when patient has exhausted all internal appeals procedures.
NORTH DAKOTA
OHIOOhio Revised Code § 3923.041 Provisions Applicable When Policy Contains Prior Authorization Requirement, § 3922.03 External Reviewhttps://codes.ohio.gov/ohio-revised-code/title-39Requires determination within forty-eight hours for urgent requests and appeals and within ten calendar days for nonurgent requests and appeals; requires authorizations related to chronic conditions to be valid for at least twelve months; requires availability of independent external review for adverse coverage determinations; requires insurers to make all of its prior authorization requirements, including specific information a patient or provider must submit to obtain approval and which services or drugs to which a prior authorization requirement exists, available on its website.
OKLAHOMA
OREGONHouse Bill 2517 (2021) (To be codified at Oregon Revised Statutes § 243.144, 243.877, 743.035, 743B.001, 743B.250, 743B.256, 743B.420, 743B.423, and 743B.602)https://olis.oregonlegislature.gov/liz/2021R1/Downloads/MeasureDocument/HB2517/EnrolledRequires insurers to provide written summary of information that the information that the insurer may consider in its utilization review of a particular condition upon request; requires insurers to provide an independent external review of adverse coverage decisions; prohibits insurers from changing prior authorization decisions made up to sixty days prior to the date service is provided unless there was misrepresentation; requires determination of nonemergency requests within two business days of receipt; prior authorizations must be valid for at least sixty days or the reasonable duration of treatment for medical services and for one year for prescription drugs.
PENNSYLVANIA
*PUERTO RICO
RHODE ISLANDRhode Island General Laws Title 28 Chapter 18.9 Benefit Determination and Utilization Review Act §§ 28-18.9-1 to -15http://webserver.rilegislature.gov/Statutes/TITLE27/27-18.9/INDEX.htmRequires determination within seventy-two hours for urgent requests and within fifteen calendar days for nonurgent requests; requires determination upon appeal within seventy-two hours for urgent appeals and within thirty calendar days for nonurgent appeals; prohibits insurers from making a determination on an appeal unless an appropriately qualified provider had made a direct communication with the patient's provider; requires insurers to provide clinical criteria for determinations upon request; requires insurers to submit to external review by an independent review organization after patient exhausts the final internal level of appeal.
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEEHealth Care Service Utilization Review Act (Codified at Tennessee Code §§ 56-6-701 to 706https://advance.lexis.com/documentpage/?pdmfid=1000516&crid=5b863c01-457a-4c8c-b0dc-76d7f3f7a984&nodeid=ACDAAGAAHAAB&nodepath=/ROOT/ACD/ACDAAG/ACDAAGAAH/ACDAAGAAHAAB&level=4&haschildren=&populated=false&title=56-6-701.%20Short%20title.&config=025054JABlOTJjNmIyNi0wYjI0LTRjZGEtYWE5ZC0zNGFhOWNhMjFlNDgKAFBvZENhdGFsb2cDFQ14bX2GfyBTaI9WcPX5&pddocfullpath=/shared/document/statutes-legislation/urn:contentItem:4WYH-TR70-R03M-J206-00008-00&ecomp=_g1_kkk&prid=2cf47394-31cb-433e-bf63-5a9d13d1dd5aRequires determinations within two business days for all requests; requires appeals to be reviewed by a physician in the same or similar specialty as one who typically manages the conditions; requires clinical criteria to be based on nationally recognized standards or standards developed under Tennessee Workers Compensation law.
TEXASHouse Bill 3459 (2021) (To be codified at Texas Insurance Code § 843.3484)https://capitol.texas.gov/tlodocs/87R/billtext/html/HB03459S.htmRequires insurers to exempt physicians or providers from prior authorization requirements for at least one calendar year if the physician or provider receives approval on at least ninety percent of prior authorization requests over a six month period.
UTAH
VERMONTVermont Statutes Title 18 § 9418b – Prior Authorization, Vermont Statutes Title 8 § 4089i – Prescription Drug Coveragehttps://legislature.vermont.gov/statutes/section/18/221/09418bRequires insurers to pay for authorized services unless there was no coverage or the determination was based on fraud or materially inaccurate information; requires determination within forty-eight hours for urgent requests and within two business days for nonurgent requests; requires insurers to annually review and remove prior authorization requirements that are no longer justified.2021–2022 House Bill 102https://legislature.vermont.gov/Documents/2022/Docs/BILLS/H-0102/H-0102%20As%20Introduced.pdfProposing elimination of prior authorization requirements for services that meet a certain annual approval rate
VIRGINIAVirginia Code § 38.2-3407.15:2 – Required Provisions Regarding Prior Authorizationhttps://law.lis.virginia.gov/vacode/title38.2/chapter34/Requires determination within twenty-four hours for urgent drug requests and within two business days for non-urgent drug requests; requires insurers to honor prior authorization for drugs from patient's previous insurer for thirty days; requires insurers to honor prior authorizations for drugs regardless of change of dosage if new dosage is consistent with FDA labelled dosages.
WASHINGTONWashington Administrative Code § 284-43-2050 – Prior Authorization Process, Revised Code of Washington § 48.43.016: Utilization Management Standards, -.535 Independent Review of Health Care Disputes, -.525 Prohibition Against Retrospective Denial , -.420 Prescription Drug Utilization Managementhttps://apps.leg.wa.gov/WAC/default.aspx?cite=284-43-2050Requires insurers to post prior authorization standards and criteria for medical necessity decisions on their website; requires determination within five calendar days for nonurgent medical service requests and within two calendar days for urgent medical service requests; requires determination within three business days for nonurgent prescription drug requests and within one business day for urgent prescription drug requests; prohibits insurers from requiring prior authorization for emergencies; prohibits retrospective denial of authorized health care; requires insurers to permit patients to seek review by an independent external review organization regarding adverse benefit decisions once patient has exhausted internal appeals.
WEST VIRGINIA2019 House Bill 2351 (Codified at West Virginia Code: §33-15-4s; §33-16-3dd; §33-24-7s; §33-25-8p; §33-25A-8s)https://code.wvlegislature.gov/33/Requires determination within seven days for nonurgent requests and within two days for urgent requests; requires prior authorization for services provided in state to remain valid for at least three months; permits health care providers to obtain a peer review of denied prior authorization requests with a health care provider in similar specialty, education, and background; insurers may only require one prior authorization for one episode of care.
WISCONSINWisconsin Statutes: § 632.85 – Prior Authorization for Emergency Medical Conditions, § 632.855 – Experimental Treatmenthttps://docs.legis.wisconsin.gov/statutes/statutes/632/vi/85Prohibits insurers from requiring prior authorization for emergency services; requires determination within five working days for experimental treatment authorization requests.
WYOMING
*GUAM
LAST UPDATE9/20229/20229/20229/2022

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