AB295

Existing law authorizes certain health insurers to require prior authorization before an insured may receive coverage for health and dental care in certain circumstances. If an insurer requires prior authorization, existing law requires the insurer to respond to a request for prior authorization within 20 days of the receiving the request. (NRS 687B.225) Sections 9 and 17 of this bill require an insurer, including Medicaid and the Children's Health Insurance Program, to approve or make an adverse determination on a request for prior authorization, or request additional, medically relevant information within: (1) five days after receiving the request, for medical or dental care that is not urgent; or (2) forty-eight hours after receiving the request, for care that is urgent. Sections 9 and 17 require an insurer to transmit certain information to an insured and his or her provider of health care after making an adverse determination on a request for prior authorization pertaining to the insured. Sections 9 and 17 also provide that a request for prior authorization that has been approved by the insurer for a continuous course of treatment relating to a chronic or long-term condition remains valid for 12 months, with certain exceptions. Sections 6 and 18 of this bill require an insurer that employs or utilizes an artificial intelligence system or automated decision tool and, if such a system or tool is used under Medicaid or the Children's Health Insurance Program, the De

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