Mississippi 2023 Regular Session Status: To Executive Bipartisan · 6 R · 1 D cosponsors

SB 2622 — Mississippi Prior Authorization Reform Act; enact.

Last action — Vetoed

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  1. ✓
    Introduced
  2. ✓
    In Committee
  3. ✓
    Passed Senate
  4. ✓
    Passed House
  5. 5
    To Executive
  6. 6
    Enacted

This bill died with 2023 Regular Session. It reached “To Executive” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.

This bill is no longer active — its legislative session has ended, so there is no live prognosis. It would have to be reintroduced in the current session to move again.

Bill Text

What changed in the latest version

689 added · 668 removed

Plain-language change summary

The recent amendment to SB 2622 outlines specific deadlines and requirements for health care professionals and insurance providers regarding the prior authorization process for medical treatments. By January 1, 2024, a new process must be established, and by January 1, 2026, all health care providers must use this process. This change is significant because it aims to streamline approvals for nonurgent and urgent medical procedures, ensuring patients receive the care they need without unnecessary delays. Additionally, it sets clear guidelines for how long authorizations remain valid, which can help improve continuity of care for patients with chronic conditions.

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Insurance Horhn, DeLano, Hill, Parker, Jackson, Sparks COMMITTEE SUBSTITUTE FOR SENATE BILL NO.
Insurance Horhn, DeLano, Hill, Parker, Jackson, Sparks SENATE BILL NO.
2622 AN ACT TO ENACT THE MISSISSIPPI PRIOR AUTHORIZATION REFORM ACT;
2622 (As Sent to Governor) AN ACT TO ENACT THE MISSISSIPPI PRIOR AUTHORIZATION REFORM ACT;
TO REQUIRE ALL HEALTH CARE PROFESSIONALS AND HEALTH CARE PROVIDERS TO USE THAT PROCESS NOT LATER THAN JANUARY 1, 2026;
TO ESTABLISH THE PROCEDURE FOR THE CONTINUITY OF PRIOR APPROVALS FROM PREVIOUS HEALTH INSURANCE ISSUERS TO CURRENT ISSUERS;
TO ESTABLISH THE PROCEDURE FOR THE CONTINUITY OF PRIOR APPROVALS FROM PREVIOUS S.
TO PROVIDE THAT A FAILURE BY A HEALTH INSURANCE ISSUER TO COMPLY WITH THE DEADLINES S.
2622 *SS36/R452CS* ~ OFFICIAL ~ G1/2 23/SS36/R452CS PAGE 1 AND OTHER REQUIREMENTS SPECIFIED IN THIS ACT SHALL RESULT IN ANY HEALTH CARE SERVICES SUBJECT TO REVIEW TO BE AUTOMATICALLY DEEMED AUTHORIZED BY THE HEALTH INSURANCE ISSUER OR ITS CONTRACTED PRIVATE REVIEW AGENT;
2622 *SS08/R452SG* ~ OFFICIAL ~ G1/2 23/SS08/R452SG PAGE 1 HEALTH INSURANCE ISSUERS TO CURRENT ISSUERS;
TO PROVIDE THAT A FAILURE BY A HEALTH INSURANCE ISSUER TO COMPLY WITH THE DEADLINES AND OTHER REQUIREMENTS SPECIFIED IN THIS ACT SHALL RESULT IN ANY HEALTH CARE SERVICES SUBJECT TO REVIEW TO BE AUTOMATICALLY DEEMED AUTHORIZED BY THE HEALTH INSURANCE ISSUER OR ITS CONTRACTED PRIVATE REVIEW AGENT;
TO AUTHORIZE THE DEPARTMENT TO IMPOSE UPON A PRIVATE REVIEW AGENT, HEALTH BENEFIT PLAN OR HEALTH INSURANCE ISSUER AN ADMINISTRATIVE FINE NOT TO EXCEED $10,000.00 PER VIOLATION OF THE ACT;
TO AUTHORIZE THE STATE DEPARTMENT OF HEALTH TO IMPOSE UPON A PRIVATE REVIEW AGENT, HEALTH BENEFIT PLAN OR HEALTH INSURANCE ISSUER AN ADMINISTRATIVE FINE NOT TO EXCEED $10,000 PER VIOLATION OF THE ACT;
TO REQUIRE HEALTH INSURANCE ISSUERS TO NOTIFY THE COMMISSIONER OF INSURANCE OF SUSPECTED SUBMISSIONS OF FALSE REQUESTS FOR PRIOR AUTHORIZATION;
TO REQUIRE THE COMMISSIONER TO HAVE AN ADMINISTRATIVE HEARING ON SUCH MATTERS TO RESOLVE THE ISSUE;
Legislative Findings.
Legislative findings.
The Mississippi Legislature hereby finds and declares that:
The Mississippi Legislature finds and declares that:
(b) Prior authorization programs may be subject to member coverage agreements and medical policies but shall not hinder the independent medical judgment of a physician or other health care provider;
(b) Prior authorization programs may be subject to member coverage agreements and medical policies, but shall not hinder the independent medical judgment of a physician or other health care provider;
SECTION 3.
S.
Applicability and Scope.
This act applies to every health insurance issuer and all health benefit plans, as both terms are defined in Section 83-9-6.3, and all private review S.
2622 *SS36/R452CS* ~ OFFICIAL ~ 23/SS36/R452CS PAGE 2 agents and utilization review plans, as both terms are defined in Section 41-83-1, with the exception of employee or employer self-insured health benefit plans under the federal Employee Retirement Income Security Act of 1974, health care provided pursuant to the Workers' Compensation Act or the Mississippi State & School Employees' Life and Health Insurance Plan.
2622 *SS08/R452SG* ~ OFFICIAL ~ 23/SS08/R452SG PAGE 2 SECTION 3.
This act does not diminish the duties and responsibilities under other federal or state law or rules promulgated thereunder applicable to a health insurer, health insurance issuer, health benefit plan, private review agent or utilization review plan, including but not limited to the requirement of a certificate in accordance with Section 41-83-3.
Applicability and scope.
This act applies to every health insurance issuer and all health benefit plans, as both terms are defined in Section 83-9-6.3, and all private review agents and utilization review plans, as both terms are defined in Section 41-83-1, with the exception of employee or employer self-insured health benefit plans under the federal Employee Retirement Income Security Act of 1974, health care provided pursuant to the Workers' Compensation Act or the Mississippi State and School Employees' Life and Health Insurance Plan.
This act does not diminish the duties and responsibilities under other federal or state law or rules promulgated under those laws applicable to a health insurer, health insurance issuer, health benefit plan, private review agent or utilization review plan, including, but not limited to, the requirement of a certificate in accordance with Section 41-83-3.
For purposes of this act, unless the context requires otherwise, the following terms shall have the meanings ascribed herein:
For purposes of this act, unless the context requires otherwise, the following terms shall have the meanings as defined in this section:
(a) "Adverse determination" means a determination by a health insurance issuer that, based upon the information provided, a request for a benefit under the health insurance issuer's health benefit plan upon application of any utilization review technique does not meet the health insurance issuer's requirements for medical necessity, appropriateness, health care setting, level of care, or effectiveness or is determined to be experimental or investigational and the requested benefit is therefore denied, reduced, or terminated or payment is not provided or made, in whole or in part, for the benefit;
(a) "Adverse determination" means a determination by a health insurance issuer that, based upon the information provided, a request for a benefit under the health insurance issuer's health benefit plan upon application of any utilization review technique does not meet the health insurance issuer's requirements for medical necessity, appropriateness, health care setting, level of care, or effectiveness or is determined to be experimental or S.
the denial, reduction, or S.
2622 *SS36/R452CS* ~ OFFICIAL ~ 23/SS36/R452CS PAGE 3 termination of or failure to provide or make payment, in whole or in part, for a benefit based on a determination by a health insurance issuer that a preexisting condition was present before the effective date of coverage;
2622 *SS08/R452SG* ~ OFFICIAL ~ 23/SS08/R452SG PAGE 3 investigational and the requested benefit is therefore denied, reduced, or terminated or payment is not provided or made, in whole or in part, for the benefit;
the denial, reduction, or termination of or failure to provide or make payment, in whole or in part, for a benefit based on a determination by a health insurance issuer that a preexisting condition was present before the effective date of coverage;
(e) "Department" means the Mississippi State Department of Health.
(e) "Department" means the State Department of Health.
(f) "Emergency medical condition" means a medical condition manifesting itself by acute symptoms of sufficient severity, including, but not limited to, severe pain, such that a prudent layperson who possesses an average knowledge of health and S.
(f) "Emergency medical condition" means a medical condition manifesting itself by acute symptoms of sufficient severity, including, but not limited to, severe pain, such that a S.
2622 *SS36/R452CS* ~ OFFICIAL ~ 23/SS36/R452CS PAGE 4 medicine could reasonably expect the absence of immediate medical attention to result in:
2622 *SS08/R452SG* ~ OFFICIAL ~ 23/SS08/R452SG PAGE 4 prudent layperson who possesses an average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in:
(k) "Health care service" means any services or level of services included in the furnishing to an individual of medical care or the hospitalization incident to the furnishing of such care, as well as the furnishing to any person of any other services for the purpose of preventing, alleviating, curing, or S.
(k) "Health care service" means any services or level of services included in the furnishing to an individual of medical care or the hospitalization incident to the furnishing of such S.
2622 *SS36/R452CS* ~ OFFICIAL ~ 23/SS36/R452CS PAGE 5 healing human illness or injury, including behavioral health, mental health, home health and pharmaceutical services and products.
2622 *SS08/R452SG* ~ OFFICIAL ~ 23/SS08/R452SG PAGE 5 care, as well as the furnishing to any person of any other services for the purpose of preventing, alleviating, curing, or healing human illness or injury, including behavioral health, mental health, home health and pharmaceutical services and products.
Any provision of this act that applies to a "health insurance issuer" also applies to any person or entity covered under the scope of this act in Section 3.
Any provision of this act that applies to a "health insurance issuer" also applies to any person or entity covered under the scope of this act in Section 3 of this act.
(o) "Prior authorization" means the process by which a health insurance issuer determines the medical necessity and medical appropriateness of an otherwise covered health care S.
S.
2622 *SS36/R452CS* ~ OFFICIAL ~ 23/SS36/R452CS PAGE 6 service before the rendering of such health care service.
2622 *SS08/R452SG* ~ OFFICIAL ~ 23/SS08/R452SG PAGE 6 (o) "Prior authorization" means the process by which a health insurance issuer determines the medical necessity and medical appropriateness of an otherwise covered health care service before the rendering of such health care service.
(1) A health insurance issuer shall maintain a complete list of services for which prior authorization is required, including for all services where prior authorization is S.
(1) A health insurance issuer shall maintain a S.
2622 *SS36/R452CS* ~ OFFICIAL ~ 23/SS36/R452CS PAGE 7 performed by an entity under contract with the health insurance issuer.
2622 *SS08/R452SG* ~ OFFICIAL ~ 23/SS08/R452SG PAGE 7 complete list of services for which prior authorization is required, including for all services where prior authorization is performed by an entity under contract with the health insurance issuer.
(c) Where applicable, the date that prior authorization was removed for Mississippi;
S.
and S.
2622 *SS36/R452CS* ~ OFFICIAL ~ 23/SS36/R452CS PAGE 8 (d) Where applicable, access to a standardized electronic prior authorization request transaction process.
2622 *SS08/R452SG* ~ OFFICIAL ~ 23/SS08/R452SG PAGE 8 (c) Where applicable, the date that prior authorization was removed for Mississippi;
and (d) Where applicable, access to a standardized electronic prior authorization request transaction process.
or (b) Prior authorization for the health care service is not required.
or S.
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S.
2622 *SS36/R452CS* ~ OFFICIAL ~ 23/SS36/R452CS PAGE 9 (6) If a health insurance issuer intends either to implement a new prior authorization requirement or restriction or amend an existing requirement or restriction, the health insurance issuer shall provide contracted health care professionals and contracted health care providers of enrollees written notice of the new or amended requirement or amendment no less than sixty (60) days before the requirement or restriction is implemented.
2622 *SS08/R452SG* ~ OFFICIAL ~ 23/SS08/R452SG PAGE 9 (b) Prior authorization for the health care service is not required.
(6) If a health insurance issuer intends either to implement a new prior authorization requirement or restriction or amend an existing requirement or restriction, the health insurance issuer shall provide contracted health care professionals and contracted health care providers of enrollees written notice of the new or amended requirement or amendment no less than sixty (60) days before the requirement or restriction is implemented.
(c) The number of prior authorization requests denied during the previous plan year by the health insurance issuer, S.
S.
2622 *SS36/R452CS* ~ OFFICIAL ~ 23/SS36/R452CS PAGE 10 health benefit plan, or private review agent with respect to each service described in paragraph (a) of this subsection and the top five (5) reasons for denial;
2622 *SS08/R452SG* ~ OFFICIAL ~ 23/SS08/R452SG PAGE 10 (c) The number of prior authorization requests denied during the previous plan year by the health insurance issuer, health benefit plan, or private review agent with respect to each service described in paragraph (a) of this subsection and the top five (5) reasons for denial;
If any health insurance issuer requires prior authorization of a health care service the insurer or its designee utilization review organization shall, by January 1, 2024, make available a standardized electronic prior authorization request transaction process utilizing an internet webpage, internet webpage portal, or similar electronic, internet, and web-based system.
(1) If any health insurance issuer requires prior authorization of a health care service, the insurer or its designee utilization review organization shall, by January 1, 2024, make available a standardized electronic prior authorization request transaction process using an internet webpage, internet webpage portal, or similar electronic, internet, and web-based system.
SECTION 7.
(2) Not later than January 1, 2026, all health care professionals and health care providers shall be required to use the standardized electronic prior authorization request transaction process made available as required by subsection (1) of this section.
Prior authorizations in nonurgent circumstances.
S.
Notwithstanding any other provision of law, if a health insurance issuer requires prior authorization of a health care service, the health insurance issuer must make an approval or adverse determination and notify the enrollee, the enrollee's health care professional, and the enrollee's health care provider of the approval or adverse determination as required by applicable law, S.
2622 *SS36/R452CS* ~ OFFICIAL ~ 23/SS36/R452CS PAGE 11 but no later than two (2) working days after obtaining all necessary information to make the approval or adverse determination.
2622 *SS08/R452SG* ~ OFFICIAL ~ 23/SS08/R452SG PAGE 11 SECTION 7.
Prior authorizations in nonurgent circumstances.
If a health insurance issuer requires prior authorization of a health care service, the health insurance issuer must make an approval or adverse determination and notify the enrollee, the enrollee's health care professional, and the enrollee's health care provider of the approval or adverse determination as required by applicable law, but no later than two (2) working days after obtaining all necessary information to make the approval or adverse determination.
(1) If requested by a treating health care provider or health care professional for an enrollee, and notwithstanding any other provision of law, a health insurance issuer must render an approval or adverse determination concerning urgent health care services and notify the enrollee, the enrollee's health care professional and the enrollee's health care provider of that approval or adverse determination as required by law, but not later than twenty-four (24) hours after receiving all information needed to complete the review of the requested health care services.
(1) If requested by a treating health care provider or health care professional for an enrollee, a health insurance issuer must render an approval or adverse determination concerning urgent health care services and notify the enrollee, the enrollee's health care professional and the enrollee's health care provider of that approval or adverse determination as required by law, but not later than twenty-four (24) hours after receiving all information needed to complete the review of the requested health care services.
(2) To facilitate the rendering of a prior authorization determination in conformance with this section, a health insurance issuer must establish a mechanism to ensure health care professionals have access to appropriately trained and licensed clinical personnel who have access to physicians for consultation, designated by the plan to make such determinations for prior authorization concerning urgent care services.
(2) To facilitate the rendering of a prior authorization determination in conformance with this section, a health insurance issuer must establish a mechanism to ensure health care S.
S.
2622 *SS36/R452CS* ~ OFFICIAL ~ 23/SS36/R452CS PAGE 12 SECTION 9.
2622 *SS08/R452SG* ~ OFFICIAL ~ 23/SS08/R452SG PAGE 12 professionals have access to appropriately trained and licensed clinical personnel who have access to physicians for consultation, designated by the plan to make such determinations for prior authorization concerning urgent care services.
SECTION 9.
(2) Notwithstanding the foregoing, the health insurance issuer must also comply with Section 41-83-31 requiring concurrence in the adverse determination by a physician licensed to practice in Mississippi.
(2) Notwithstanding the foregoing, the health insurance issuer must also comply with Section 41-83-31 requiring concurrence in the adverse determination by a physician certified by the board(s) of the American Board of Medical Specialists or the American Board of Osteopathy within the relevant specialty.
(a) The reasons for the adverse determination and related evidence-based criteria, including a description of any missing or insufficient documentation;
S.
(b) The right to appeal the adverse determination;
(c) Instructions on how to file the appeal;
and S.
2622 *SS36/R452CS* ~ OFFICIAL ~ 23/SS36/R452CS PAGE 13 (d) Additional documentation necessary to support the appeal.
2622 *SS08/R452SG* ~ OFFICIAL ~ 23/SS08/R452SG PAGE 13 (a) The reasons for the adverse determination and related evidence-based criteria, including a description of any missing or insufficient documentation;
(b) The right to appeal the adverse determination;
(c) Instructions on how to file the appeal;
and (d) Additional documentation necessary to support the appeal.
(a) Possess a current and valid nonrestricted license to practice medicine by the Mississippi State Board of Medical Licensure;
(a) Possess a current and valid nonrestricted license to practice medicine in any United States jurisdiction;
and (e) Consider all known clinical aspects of the health care service under review, including, but not limited to, a review of all pertinent medical records provided to the health insurance issuer by the enrollee's health care professional or health care provider and any medical literature provided to the health insurance issuer by the health care professional or health care provider.
and (e) Consider all known clinical aspects of the health care service under review, including, but not limited to, a review of all pertinent medical records provided to the health insurance issuer by the enrollee's health care professional or health care S.
S.
2622 *SS36/R452CS* ~ OFFICIAL ~ 23/SS36/R452CS PAGE 14 (2) Notwithstanding the foregoing, a licensed health care professional who satisfies the requirements in this section may review appeal requests submitted by a health care professional licensed in the same profession.
2622 *SS08/R452SG* ~ OFFICIAL ~ 23/SS08/R452SG PAGE 14 provider and any medical literature provided to the health insurance issuer by the health care professional or health care provider.
(2) Notwithstanding the foregoing, a licensed health care professional who satisfies the requirements in this section may review appeal requests submitted by a health care professional licensed in the same profession.
(2) Notwithstanding any other provision of law, if a claim is properly coded and submitted timely to a health insurance issuer, the health insurance issuer shall make payment according to the terms of coverage on claims for health care services for which prior authorization was required and approval received before the rendering of health care services, unless one (1) of the following occurs:
(2) Notwithstanding any other provision of law, if a claim is properly coded and submitted timely to a health insurance issuer, the health insurance issuer shall make payment according to the terms of coverage on claims for health care services for S.
S.
2622 *SS36/R452CS* ~ OFFICIAL ~ 23/SS36/R452CS PAGE 15 (a) It is timely determined that the enrollee's health care professional or health care provider knowingly and without exercising prudent clinical judgment provided health care services that required prior authorization from the health insurance issuer or its contracted private review agent without first obtaining prior authorization for those health care services;
2622 *SS08/R452SG* ~ OFFICIAL ~ 23/SS08/R452SG PAGE 15 which prior authorization was required and approval received before the rendering of health care services, unless one (1) of the following occurs:
(a) It is timely determined that the enrollee's health care professional or health care provider knowingly and without exercising prudent clinical judgment provided health care services that required prior authorization from the health insurance issuer or its contracted private review agent without first obtaining prior authorization for those health care services;
(3) Nothing in this section shall preclude a private review agent or a health insurance issuer from performing post-service reviews of health care claims for purposes of payment integrity or for the prevention of fraud, waste, or abuse.
2622 *SS36/R452CS* ~ OFFICIAL ~ 23/SS36/R452CS PAGE 16 SECTION 14.
2622 *SS08/R452SG* ~ OFFICIAL ~ 23/SS08/R452SG PAGE 16 (3) Nothing in this section shall preclude a private review agent or a health insurance issuer from performing post-service reviews of health care claims for purposes of payment integrity or for the prevention of fraud, waste, or abuse.
SECTION 14.
(1) A prior authorization approval shall be valid for the lesser of six (6) months after the date the health care professional or health care provider receives the prior authorization approval or the length of treatment as determined by the patient's health care professional or the renewal of the plan, and the approval period shall be effective regardless of any changes, including any changes in dosage for a prescription drug prescribed by the health care professional.
(1) A prior authorization approval shall be valid for the lesser of six (6) months after the date the health care professional or health care provider receives the prior authorization approval or the length of treatment as determined by the patient's health care professional or the renewal of the policy or plan, and the approval period shall be effective regardless of any changes, including any changes in dosage for a prescription drug prescribed by the health care professional.
All dosage increases must be based on established evidentiary standards and nothing in this section shall prohibit a health insurance issuer from having safety edits in place.
All dosage increases must be based on established evidentiary standards, and nothing in this section shall prohibit a health insurance issuer from having safety edits in place.
(1) If a health insurance issuer requires a prior authorization for a recurring health care service or maintenance medication for the treatment of a chronic or long-term condition, the approval shall remain valid for the lesser of twelve (12) months from the date the health care professional or health care provider receives the prior authorization approval or the length of the treatment as S.
(1) If a health insurance issuer requires a prior authorization for a recurring health care service or maintenance medication for the S.
2622 *SS36/R452CS* ~ OFFICIAL ~ 23/SS36/R452CS PAGE 17 determined by the patient's health care professional.
2622 *SS08/R452SG* ~ OFFICIAL ~ 23/SS08/R452SG PAGE 17 treatment of a chronic or long-term condition, the approval shall remain valid for the lesser of twelve (12) months from the date the health care professional or health care provider receives the prior authorization approval or the length of the treatment as determined by the patient's health care professional.
(2) Nothing in this section shall require a policy to cover any care, treatment or services for any health condition that the terms of coverage otherwise completely exclude from the policy's covered benefits without regard for whether the care, treatment, or services are medically necessary.
(2) Nothing in this section shall require a policy or plan to cover any care, treatment or services for any health condition that the terms of coverage otherwise completely exclude from the policy's or plan's covered benefits without regard for whether the care, treatment, or services are medically necessary.
(3) If there is a change in coverage of or approval criteria for a previously authorized health care service, the change in coverage or approval criteria does not affect an enrollee who received prior authorization approval before the effective date of the change for the remainder of the enrollee's plan year.
2622 *SS36/R452CS* ~ OFFICIAL ~ 23/SS36/R452CS PAGE 18 (4) Except to the extent required by medical exceptions processes for prescription drugs, nothing in this section shall require a policy to cover any care, treatment or services for any health condition that the terms of coverage otherwise completely exclude from the policy's covered benefits without regard for whether the care, treatment or services are medically necessary.
2622 *SS08/R452SG* ~ OFFICIAL ~ 23/SS08/R452SG PAGE 18 (3) If there is a change in coverage of or approval criteria for a previously authorized health care service, the change in coverage or approval criteria does not affect an enrollee who received prior authorization approval before the effective date of the change for the remainder of the enrollee's plan year.
(4) Except to the extent required by medical exceptions processes for prescription drugs, nothing in this section shall require a policy or plan to cover any care, treatment or services for any health condition that the terms of coverage otherwise completely exclude from the policy's or plan's covered benefits without regard for whether the care, treatment or services are medically necessary.
(1) In addition to the enforcement powers granted to it by law to enforce the provisions of this act, the department is hereby granted specific authority to issue a cease-and-desist order or require a private review agent or health insurance issuer to submit a plan of correction for violations of this act, or both.
(1) In addition to the enforcement powers granted to it by law to enforce the provisions of this act, the department is granted specific authority to issue a cease-and-desist order or require a private review agent or health insurance issuer to submit a plan of correction for violations of this act, or both.
Subject to regulations promulgated by the department pursuant to provisions of the Mississippi Administrative Procedure Law, the department may impose upon a private review agent, health benefit plan or health insurance issuer an administrative fine not to exceed Ten Thousand Dollars ($10,000.00) per violation for failure to submit a requested plan of correction, failure to comply with its plan of correction, or repeated violations of this act.
Subject to regulations promulgated by the department under the provisions of S.
The department S.
2622 *SS36/R452CS* ~ OFFICIAL ~ 23/SS36/R452CS PAGE 19 may also exercise all authority granted to it pursuant to Section 41-83-13 to deny or revoke a certificate of a private review agent for a violation of this act.
2622 *SS08/R452SG* ~ OFFICIAL ~ 23/SS08/R452SG PAGE 19 the Mississippi Administrative Procedure Law, the department may impose upon a private review agent, health benefit plan or health insurance issuer an administrative fine not to exceed Ten Thousand Dollars ($10,000.00) per violation for failure to submit a requested plan of correction, failure to comply with its plan of correction, or repeated violations of this act.
All fines collected by the department under this section shall be deposited into the State General Fund.
The department may also exercise all authority granted to it under Section 41-83-13 to deny or revoke a certificate of a private review agent for a violation of this act.
(3) The department shall have the authority to promulgate rules and regulations pursuant to the Mississippi Administrative Procedures Law to govern the administration of this act.
(3) The department shall have the authority to promulgate rules and regulations under the Mississippi Administrative Procedures Law to govern the administration of this act.
(1) By June 1, 2024, and each June 1 after that date, a health insurance issuer shall report to the department, on a form issued by the department, the following aggregated trend data related to the insurer's practices and experience for the prior plan year for health care services submitted for payment:
(1) By June 1, 2024, and each June 1 after that date, a health insurance issuer S.
B.
No.
2622 *SS08/R452SG* ~ OFFICIAL ~ 23/SS08/R452SG PAGE 20 shall report to the department, on a form issued by the department, the following aggregated trend data related to the insurer's practices and experience for the prior plan year for health care services submitted for payment:
S.
(d) The number of adverse determinations reversed on appeal;
B.
No.
2622 *SS36/R452CS* ~ OFFICIAL ~ 23/SS36/R452CS PAGE 20 (d) The number of adverse determinations reversed on appeal;
(2) All reports required by this section shall be considered public records pursuant to the Mississippi Public Records Act of 1983 and the department shall make all reports freely available to requestors and post all reports to its public website without redactions.
(2) All reports required by this section shall be considered public records under the Mississippi Public Records Act of 1983 and the department shall make all reports freely available to S.
B.
No.
2622 *SS08/R452SG* ~ OFFICIAL ~ 23/SS08/R452SG PAGE 21 requestors and post all reports to its public website without redactions.
False requests for prior authorization.
If a health insurance issuer has reason to believe that a health care professional or health care provider has knowingly and willingly submitted false or fraudulent requests for prior authorization to the health insurance issuer, the issuer shall notify and provide that information to the Commissioner of Insurance.
After receipt of such notification and information, the commissioner shall have an administrative hearing on the matter to resolve the issue.
SECTION 21.
Any program of utilization review with regard to hospital, medical or other health care services provided in this S.
Any program of utilization review with regard to hospital, medical or other health care services provided in this state, including, but not limited to, any prior authorization as defined in Section 4 of this act, shall comply with the following:
(a) No determination adverse to a patient or to any affected health care provider shall be made on any question relating to the necessity or justification for any form of hospital, medical or other health care services without prior evaluation and concurrence in the adverse determination by a physician licensed to practice in * * * any United States jurisdiction and certified by the board(s) of the American Board of Medical Specialists or the American Board of Osteopathy within the relevant specialty.
The physician who made the adverse S.
2622 *SS36/R452CS* ~ OFFICIAL ~ 23/SS36/R452CS PAGE 21 state, including, but not limited to, any prior authorization as defined in Section 3 of this act, shall comply with the following:
2622 *SS08/R452SG* ~ OFFICIAL ~ 23/SS08/R452SG PAGE 22 determination shall discuss the reasons for any adverse determination with the affected health care provider, if the provider so requests.
(a) No determination adverse to a patient or to any affected health care provider shall be made on any question relating to the necessity or justification for any form of hospital, medical or other health care services without prior evaluation and concurrence in the adverse determination by a physician licensed to practice in Mississippi and certified by the board(s) of the American Board of Medical Specialists or the American Board of Osteopathy within the relevant specialty.
The physician who made the adverse determination shall discuss the reasons for any adverse determination with the affected health care provider, if the provider so requests.
(b) Any determination regarding hospital, medical or other health care services rendered or to be rendered to a patient which may result in a denial of third-party reimbursement or a denial of precertification for that service shall include the evaluation, findings and concurrence of a physician trained in the relevant specialty or subspecialty and certified by the board(s) of the American Board of Medical Specialists or the American Board of Osteopathy within the relevant specialty, if requested by the S.
(b) Any determination regarding hospital, medical or other health care services rendered or to be rendered to a patient which may result in a denial of third-party reimbursement or a denial of precertification for that service shall include the evaluation, findings and concurrence of a physician trained in the relevant specialty or subspecialty and certified by the board(s) of the American Board of Medical Specialists or the American Board of Osteopathy within the relevant specialty, if requested by the patient's physician, to make a final determination that care rendered or to be rendered was, is, or may be medically inappropriate.
(c) The requirement in this section that the physician who makes the evaluation and concurrence in the adverse determination must be licensed to practice in Mississippi shall not apply to the Comprehensive Health Insurance Risk Pool Association or its policyholders and shall not apply to any utilization review company which reviews fewer than ten (10) persons residing in the State of Mississippi.
S.
2622 *SS36/R452CS* ~ OFFICIAL ~ 23/SS36/R452CS PAGE 22 patient's physician, to make a final determination that care rendered or to be rendered was, is, or may be medically inappropriate.
2622 *SS08/R452SG* ~ OFFICIAL ~ 23/SS08/R452SG PAGE 23 SECTION 22.
(c) The requirement in this section that the physician who makes the evaluation and concurrence in the adverse determination must be licensed to practice in Mississippi shall not apply to the Comprehensive Health Insurance Risk Pool Association or its policyholders and shall not apply to any utilization review company which reviews fewer than ten (10) persons residing in the State of Mississippi.
SECTION 21.
(b) "Health insurance issuer" means any entity that offers health insurance coverage through a health benefit plan, policy, or certificate of insurance subject to state law that regulates the business of insurance.
"Health insurance issuer" also includes a health maintenance organization, as defined and regulated under Section 83-41-301 et seq., and includes the Division of Medicaid for the services provided by fee-for-service and through any managed care program, coordinated care program, coordinated care organization program or health maintenance organization program implemented by the division.
2622 *SS36/R452CS* ~ OFFICIAL ~ 23/SS36/R452CS PAGE 23 (b) "Health insurance issuer" means any entity that offers health insurance coverage through a health benefit plan, policy, or certificate of insurance subject to state law that regulates the business of insurance.
2622 *SS08/R452SG* ~ OFFICIAL ~ 23/SS08/R452SG PAGE 24 (c) "Prior authorization" means a utilization management criterion used to seek permission or waiver of a drug to be covered under a health benefit plan that provides prescription drug benefits.
"Health insurance issuer" also includes a health maintenance organization, as defined and regulated under Section 83-41-301 et seq., and includes the Division of Medicaid for the services provided by fee-for-service and through any managed care program, coordinated care program, coordinated care organization program or health maintenance organization program implemented by the division.
(c) "Prior authorization" means a utilization management criterion used to seek permission or waiver of a drug to be covered under a health benefit plan that provides prescription drug benefits.
The form shall also be made available S.
The form shall also be made available electronically, and the prescribing provider may submit the completed form electronically to the health benefit plan.
Additionally, the health insurance issuer shall submit its prior authorization forms to the Mississippi Department of Insurance to be kept on file on or after January 1, 2014.
A copy of any subsequent replacements or modifications of a health insurance issuer's prior authorization form shall be filed with the Mississippi Department of Insurance and the State Department of Health within fifteen (15) days prior to use or implementation of such replacements or modifications.
S.
2622 *SS36/R452CS* ~ OFFICIAL ~ 23/SS36/R452CS PAGE 24 electronically, and the prescribing provider may submit the completed form electronically to the health benefit plan.
2622 *SS08/R452SG* ~ OFFICIAL ~ 23/SS08/R452SG PAGE 25 (3) A health insurance issuer shall respond within two (2) * * * working days upon receipt of a completed prior authorization request from a prescribing provider that was submitted using the standardized prior authorization form required by subsection (2) of this section.
Additionally, the health insurance issuer shall submit its prior authorization forms to the Mississippi Department of Insurance to be kept on file on or after January 1, 2014.
A health insurance issuer shall comply with Section 8 of this act for all urgent health care services and in conformity with Section 7 of this act for all other prior authorization requests made by a prescribing provider.
A copy of any subsequent replacements or modifications of a health insurance issuer's prior authorization form shall be filed with the Mississippi Department of Insurance and the Mississippi State Department of Health within fifteen (15) days prior to use or implementation of such replacements or modifications.
SECTION 23.
(3) A health insurance issuer shall respond within two (2) * * * working days upon receipt of a completed prior authorization request from a prescribing provider that was submitted using the standardized prior authorization form required by subsection (2) of this section.
Notwithstanding any other provision of law to the contrary, a health insurance issuer shall comply with Section 8 of this act for all urgent health care services and in conformity with Section 7 of this act for all other prior authorization requests made by a prescribing provider.
SECTION 22.
2622 *SS36/R452CS* ~ OFFICIAL ~ 23/SS36/R452CS ST:
2622 *SS08/R452SG* ~ OFFICIAL ~ 23/SS08/R452SG ST:
PAGE 25 enact.
PAGE 26 enact.
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Amendments

2 amendments

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Action History

  1. Vetoed

  2. Enrolled Bill Signed

  3. Enrolled Bill Signed

  4. Motion to Reconsider Tabled

  5. Motion to Reconsider Entered

  6. Concurred in Amend From House

  7. Returned For Concurrence

  8. Passed As Amended

  9. Amended

  10. Title Suff Do Pass As Amended

  11. Referred To Public Health and Human Services

  12. Transmitted To House

  13. Passed

  14. Committee Substitute Adopted

  15. Title Suff Do Pass Comm Sub

  16. Referred To Insurance

Sponsors

Sponsorship breakdown

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1 sponsors · 8 co-sponsors · 166 not signed on · 2 voted No

Sponsors (1)

Co-sponsors (8)

Not signed on (166)

166 members have not signed on to this bill.

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"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

Whip count is in markup. Polling the chamber and every recorded vote this session. Only the first open is slow. It’s instant for you after this. Calling the roll · Tallying · Engrossing

Votes

Concurrence in Amendment From House

Passed 50 Yea · 0 Nay · 2 Other
Party YeaNayPresentNot Voting
Unaffiliated 17000
Republican 26001
Democrat 7001
Total 50002
% of votes cast 96%0%0%4%
How each member voted (52)
Member Party Vote
Barnett — Yea
Blackmon — Yea
Branning — Yea
Butler A. (36th) — Yea
Butler K. (38th) — Yea
Caughman — Yea
Horhn — Yea
Jackson — Yea
Johnson — Yea
Jordan — Yea
McDaniel — Yea
Moran — Yea
Parker — Yea
Polk — Yea
Sojourner — Yea
Thompson — Yea
Turner-Ford — Yea
David Blount Democrat Yea
Derrick T. Simmons Democrat Yea
Hillman Terome Frazier Democrat Yea
Hob Bryan Democrat Yea
Joseph Thomas Democrat Yea
Rod Hickman Democrat Yea
Sarita Simmons Democrat Not Voting
Sollie B. Norwood Democrat Yea
Angela Burks Hill Republican Yea
Bart Williams Republican Yea
Benjamin Suber Republican Yea
Brice Wiggins Republican Yea
Briggs Hopson Republican Yea
Chad McMahan Republican Yea
Chuck Younger Republican Yea
Daniel H. Sparks Republican Yea
Dean Kirby Republican Yea
Dennis DeBar, Jr. Republican Yea
J. Walter Michel Republican Yea
Jason Barrett Republican Yea
Jeff Tate Republican Yea
Jeremy England Republican Yea
Joel R. Carter, Jr. Republican Yea
Joey Fillingane Republican Yea
Joseph M. Seymour Republican Yea
Josh Harkins Republican Yea
Kathy L. Chism Republican Yea
Kevin Blackwell Republican Yea
Lydia Graves Chassaniol Republican Yea
Michael McLendon Republican Yea
Neil S. Whaley Republican Yea
Nicole Boyd Republican Yea
Rita Potts Parks Republican Not Voting
Scott DeLano Republican Yea
Tyler McCaughn Republican Yea

Official roll call →

Passage as Amended

Passed 108 Yea · 5 Nay · 8 Other
Party YeaNayPresentNot Voting
Republican 55101
Democrat 25103
Unaffiliated 26304
Independent 2000
Total 108508
% of votes cast 89%4%0%7%
How each member voted (121)
Member Party Vote
Bailey (23rd) — Yea
Bailey — Yea
Bain — Yea
Barnett — Yea
Blackmon — Yea
Boyd (19th) — Yea
Boyd (37th) — Yea
Busby — Yea
Clarke — Yea
Darnell — Yea
Gibbs — Yea
Goodin — Yea
Jackson — Yea
Johnson — Yea
Lancaster — Yea
McLeod — Yea
Miles — Yea
Paden — Yea
Patterson — Yea
Reynolds — Yea
Stamps — Yea
Straughter — Yea
Thompson — Yea
Walker — Yea
Weathersby — Yea
Mr. Speaker — Yea
Bomgar — Nay
Criswell — Nay
Hopkins — Nay
Huddleston — Not Voting
Robinson — Not Voting
Williamson — Not Voting
Young — Not Voting
Bo Brown Democrat Yea
Bo Brown Democrat Nay
Bob Evans Democrat Yea
Bob Evans Democrat Not Voting
Bryant W. Clark Democrat Yea
Carl Mickens Democrat Yea
Cedric Burnett Democrat Yea
Cheikh Taylor Democrat Yea
Christopher M. Bell Democrat Yea
Daryl Porter Democrat Yea
Earle S. Banks Democrat Not Voting
Gregory Holloway, Sr. Democrat Yea
Hester Jackson McCray Democrat Yea
Jeffery Harness Democrat Yea
Jeffrey Hulum III Democrat Yea
Jeramey Anderson Democrat Yea
John G. Faulkner Democrat Yea
John W. Hines, Sr. Democrat Yea
Kabir Karriem Democrat Yea
Omeria Scott Democrat Not Voting
Oscar Denton Democrat Yea
Otis Anthony Democrat Yea
Percy W. Watson Democrat Yea
Robert L. Sanders Democrat Yea
Ronnie C. Crudup Democrat Yea
Solomon C. Osborne Democrat Yea
Stephanie Foster Democrat Yea
Tracey T. Rosebud Democrat Yea
Zakiya Summers Democrat Yea
Angela Cockerham Independent Yea
Shanda Yates Independent Yea
Becky Currie Republican Yea
Bill Kinkade Republican Yea
Bill Pigott Republican Yea
Billy Adam Calvert Republican Yea
Brent Anderson Republican Yea
Brent Powell Republican Yea
C. Scott Bounds Republican Yea
Carolyn Crawford Republican Yea
Casey Eure Republican Yea
Clay Deweese Republican Yea
Dan Eubanks Republican Yea
Dana McLean Republican Yea
Donnie Bell Republican Yea
Donnie Scoggin Republican Yea
Fred Shanks Republican Yea
Gene Newman Republican Yea
Greg Haney Republican Yea
Henry Zuber III Republican Yea
Jansen Owen Republican Yea
Jason White Republican Yea
Jay McKnight Republican Yea
Jeff Hale Republican Yea
Jeffrey S. Guice Republican Yea
Jerry R. Turner Republican Yea
Jill Ford Republican Yea
Jody Steverson Republican Yea
Joey Hood Republican Yea
John Read Republican Yea
John Thomas "Trey" Lamar, III Republican Yea
Joseph Tubb Republican Yea
Karl Oliver Republican Yea
Ken Morgan Republican Yea
Kent McCarty Republican Yea
Kevin Felsher Republican Yea
Kevin Ford Republican Not Voting
Kevin Horan Republican Yea
Larry Byrd Republican Yea
Lee Yancey Republican Yea
Lester Carpenter Republican Yea
Manly Barton Republican Yea
Mark Tullos Republican Yea
Missy McGee Republican Yea
Noah Sanford Republican Yea
Price Wallace Republican Yea
Randy Rushing Republican Yea
Richard Bennett Republican Yea
Rob Roberson Republican Yea
Sam C. Mims, V Republican Yea
Sam Creekmore IV Republican Yea
Shane Aguirre Republican Yea
Stacey Hobgood-Wilkes Republican Yea
Stephen A. Horne Republican Yea
Steve Massengill Republican Yea
Timmy Ladner Republican Nay
Troy Smith Republican Yea
Vince Mangold Republican Yea
William Tracy Arnold Republican Yea

Official roll call →

Passage

Passed 49 Yea · 0 Nay · 3 Other
Party YeaNayPresentNot Voting
Unaffiliated 15002
Republican 27000
Democrat 7001
Total 49003
% of votes cast 94%0%0%6%
How each member voted (52)
Member Party Vote
Barnett — Yea
Blackmon — Yea
Branning — Yea
Butler A. (36th) — Yea
Butler K. (38th) — Yea
Caughman — Yea
Horhn — Yea
Jackson — Yea
Johnson — Yea
Jordan — Yea
Moran — Yea
Parker — Yea
Polk — Yea
Thompson — Yea
Turner-Ford — Yea
McDaniel — Not Voting
Sojourner — Not Voting
David Blount Democrat Yea
Derrick T. Simmons Democrat Not Voting
Hillman Terome Frazier Democrat Yea
Hob Bryan Democrat Yea
Joseph Thomas Democrat Yea
Rod Hickman Democrat Yea
Sarita Simmons Democrat Yea
Sollie B. Norwood Democrat Yea
Angela Burks Hill Republican Yea
Bart Williams Republican Yea
Benjamin Suber Republican Yea
Brice Wiggins Republican Yea
Briggs Hopson Republican Yea
Chad McMahan Republican Yea
Chuck Younger Republican Yea
Daniel H. Sparks Republican Yea
Dean Kirby Republican Yea
Dennis DeBar, Jr. Republican Yea
J. Walter Michel Republican Yea
Jason Barrett Republican Yea
Jeff Tate Republican Yea
Jeremy England Republican Yea
Joel R. Carter, Jr. Republican Yea
Joey Fillingane Republican Yea
Joseph M. Seymour Republican Yea
Josh Harkins Republican Yea
Kathy L. Chism Republican Yea
Kevin Blackwell Republican Yea
Lydia Graves Chassaniol Republican Yea
Michael McLendon Republican Yea
Neil S. Whaley Republican Yea
Nicole Boyd Republican Yea
Rita Potts Parks Republican Yea
Scott DeLano Republican Yea
Tyler McCaughn Republican Yea

Official roll call →

Subjects

healthcare health-insurance
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Frequently asked questions

Who sponsors SB 2622?
SB 2622 is sponsored by Horhn, Scott DeLano (Republican), Angela Burks Hill (Republican), Parker, Daniel H. Sparks (Republican), J. Walter Michel (Republican), Michael McLendon (Republican), Nicole Boyd (Republican), and Reginald Jackson (Democrat).
What is the current status of SB 2622?
This bill died with 2023 Regular Session. It reached “To Executive” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.
Where can I track SB 2622?
Track SB 2622 free on One Click Politics — get push/email alerts when it moves.

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