With regard to health-care services, section 1 of the bill requires
a health insurance carrier (carrier) or private utilization review organization, as applicable, to offer a provider with at least a 95%
approval rate of prior authorization requests over the prior 12 months an alternative to prior authorization requirements, including an exemption from the requirements, incentive awards, or other innovative programs, to reward provider compliance.
With regard to drug benefits, section 2 requires a carrier or
pharmacy benefit management firm, as applicable, to offer the same types of alternatives to prior authorization requirements to a provider who has at least a 95% approval rate of prior authorization requests over the prior 12 months.
