New laws in effect for 2021
Following are the new laws that went into effect on January 1, 2021.
Health and Human Services
A new law modifies statutes on healthcare services utilization and prior authorization requirements to modify timelines for determinations and appeals, provide for continuity of care and improve public access to information.
Under the law, if a person switches health plan companies, their new provider will be required to comply with previous prior authorizations for healthcare services for the first 60 days after enrollment while a new utilization review is conducted. The enrollee or a medical professional acting on their behalf will be required to submit documentation to access this.
If a utilization review organization changes its coverage terms or clinical criteria during a plan year, those changes will not apply until the next year for any enrollee who received prior authorization for a healthcare service that would be affected, with some exceptions.
The law will also require utilization review organizations to submit their current requirements and restrictions for prior authorization determinations to the health plan companies for which they conduct reviews.
The health plan companies, in turn, will be required to post this information on their public websites in easy-to-understand language.
In addition, health plan companies will be required to post certain data on their public websites, including the number of prior authorization requests for which an authorization was issued and the reasons for prior authorization denial. . .