HB 144 — An Act relating to prior authorization requests for medical care covered by a health care insurer; relating to a prior authorization application programming interface; relating to step therapy; and providing for an effective date.

34-LS0780\N34-LS0780\A CS FOR HOUSE BILL NO.

144(HSS)144 IN THE LEGISLATURE OF THE STATE OF ALASKA THIRTY-FOURTH LEGISLATURE - FIRST SESSION BY THEREPRESENTATIVES HOUSERUFFRIDGE, HEALTHPrax, ANDHimschoot SOCIALIntroduced: SERVICES COMMITTEE Referred:

Labor3/21/25 andReferred: Commerce Sponsor(s):

REPRESENTATIVESHealth RUFFRIDGE,and Prax,Social HimschootServices, Labor and Commerce A BILL FOR AN ACT ENTITLED "An Act relating to prior authorization requests for medical care covered by a health care insurer;

(2) require a health care insur,insurr, when determining coverage for services provided by a religious nonmedical provider, to (A) apply medically based eligibility standards;

(B) use health care providers to determine access by a covered HB0144bHB0144a -1- CSHBHB 144(HSS)144 New Text Underlined [DELETED TEXT BRACKETED] 34-LS0780\N34-LS0780\A person;

or CSHBHB 144(HSS)144 -2- HB0144bHB0144a New Text Underlined [DELETED TEXT BRACKETED] 34-LS0780\N34-LS0780\A (2) three calendar days after receiving a standard request.

(c) If the prior authorization standards published by the hth care insurer differ from those published by the health care insurer's utilization review organization, HB0144bHB0144a -3- CSHBHB 144(HSS)144 New Text Underlined [DELETED TEXT BRACKETED] 34-LS0780\N34-LS0780\A the health care insurer shall use the prior authorization standard most favorable to the covered person.

(e) If the prior authorization requirement is terminated, a health care insurer shall indicate on its Internet website the date the prior authorization requirement was removed for a policy issued or delivered in this state.

If the treatment plan for a chronic condition is unchanged and the covered person's health care provider submits to the health care insurer certification of compliance with the current treatment plan, the health care insurer shall automatically renew the prior HB 144 -4- HB0144a New Text Underlined [DELETED TEXT BRACKETED] 34-LS0780\A authorization approval for the chronic condition for an additional 12-month period.

(b) Except for a prior authorization for a chronic condition subject to (a) of this section, a prior authorization is valid for a period of 90 calendar days or a duration CSHB 144(HSS) -4- HB0144b New Text Underlined [DELETED TEXT BRACKETED] 34-LS0780\N that is clinically appropriate, whichever is longer.

A health care insurer shall maintain a prior authorization application programming interface that automates the process for health care providers to determine whether a prior authorization is required for medical care, identify prior authorization HB0144a -5- HB 144 New Text Underlined [DELETED TEXT BRACKETED] 34-LS0780\A information and documentation requirements, and facilitate the exchange of prior authorization requests and determinations from its electronic health records or practice management system.

The application programming interface must be consistent with HB0144b -5- CSHB 144(HSS) New Text Underlined [DELETED TEXT BRACKETED] 34-LS0780\N the technical standards and implementation dates established in the Centers for Medicare and Medicaid Services rules on interoperability and patient access.

(b) If coverage of a prescription drug for the treatment of any medical condition is restricted by a health care insurer or utilization review organization because of a step therapy protocol, the health care insurer or utilization review organization must provide a covered person and the covered person's health care provider with access to a clear, convenient, and readily accessible process for requesting an exception to application of the step therapy protocol.pocol.

A health care insurer or utilization review organization may use its existing medical exceptions HB 144 -6- HB0144a New Text Underlined [DELETED TEXT BRACKETED] 34-LS0780\A process to satisfy this requirement.

The health care insurer or utilization review organization shall disclose the process to the covered person and the covered person's health care provider, along with the information needed to process the request, and CSHB 144(HSS) -6- HB0144b New Text Underlined [DELETED TEXT BRACKETED] 34-LS0780\N make the process available on the health care insurer's Internet website for the plan.

The report mustmnclude include (1) documentation of compliance with prior authorization response HB0144a -7- HB 144 New Text Underlined [DELETED TEXT BRACKETED] 34-LS0780\A times and other prior authorization requirements;

HB0144b -7- CSHB 144(HSS) New Text Underlined [DELETED TEXT BRACKETED] 34-LS0780\N (3) information on the implementation and functioning of any prior authorization application programming interfaces;

HB 144 -8- HB0144a New Text Underlined [DELETED TEXT BRACKETED] 34-LS0780\A (d) The director shall adopt regulations establishing penalties for noncompliance with AS 21.07.100 - 21.07.180.

CSHB 144(HSS) -8- HB0144b New Text Underlined [DELETED TEXT BRACKETED] 34-LS0780\N * Sec.

(18) "prior authorization" means the process used by a health care insurer to determine the medical necessity or medical appropriateness of covered medical care before the medical care is provided;provided or a requirement that a covered person or health care provider notify a health care insurer before receiving or providing medical care;

(20) "step-therapy protocol" means a protocol, policy, or program used HB0144a -9- HB 144 New Text Underlined [DELETED TEXT BRACKETED] 34-LS0780\A by a health care insurer or utilization review organization that establishes which prescription drugs are medically appropriate for a particular covered person and the specific sequence in which the prescription drugs should be administered for a specified medical condition, whether by self-administration or administration by a health care provider, under a pharmacy or medical benefit of a health care insurance HB0144b -9- CSHB 144(HSS) New Text Underlined [DELETED TEXT BRACKETED] 34-LS0780\N plan;

CSHBHB 144(HSS)144 -10- HB0144bHB0144a New Text Underlined [DELETED TEXT BRACKETED]