SUBPART A-4. REDUCING ADMINISTRATIVE BURDENS

IN HEALTH INSURANCE

§1020.61. Selective application of prior authorization

            A.(1) Every health insurance issuer authorized to do business in this state shall implement and maintain a program that allows for the selective application of reducing prior authorization requirements that are based on the stratification of healthcare providers' performance and adherence to evidence-based medicine. The program shall promote quality, affordable health care and reduce unnecessary administrative burdens for both the health insurance issuer and the healthcare provider. Criteria for participation by healthcare providers and the healthcare services included in the program excluding pharmacy services shall be at the sole discretion of the health insurance issuer. A health insurance issuer shall submit to the Department of Insurance a filing, in accordance with Subsection B of this Section, concerning the program that includes a full narrative description, the criteria for participation, a listing of the procedures and services subject to selective application of prior authorization, and the number of healthcare providers participating in the program.

            (2) For the purposes of this Section, "health insurance issuer" has the same meaning as provided for in R.S. 22:1019.1.

            B. The filing shall be in a form and manner provided for by the Department of Insurance, promulgated in accordance with the Administrative Procedure Act, and shall be submitted initially by July 1, 2023, and each time the health insurance issuer makes a filing in accordance with R.S. 22:571 thereafter.

            Acts 2022, No. 432, §1, eff. June 16, 2022.