AB463

Existing law authorizes certain health insurers to require prior authorization before an insured may receive coverage for medical and dental care in certain circumstances. If an insurer requires prior authorization, existing law requires the insurer to: (1) file its procedure for obtaining prior authorization with the Commissioner of Insurance for approval; and (2) respond to a request for prior authorization within 20 days after receiving the request. (NRS 687B.225) Sections 27 and 45 of this bill require private insurers and insurers providing coverage for recipients of Medicaid and the Children's Health Insurance Program, respectively, to respond to a request for prior authorization within 2 business days after receiving the request, unless certain nationally recognized operating rules governing prior authorization would allow the insurer to have additional time to respond to the particular request. In such a case, sections 27 and 45 authorize an insurer to respond to the request within the period of time prescribed by the operating rules, unless doing so would result in the insurer responding to the request more than 7 calendar days after receiving the request. Sections 19 and 48 of this bill prohibit insurers from requiring an insured to obtain prior authorization for: (1) certain preventive care services; (2) hospice care provided to pediatric patients; and (3) care provided to treat neonatal abstinence syndrome. Section 19 additionally prohibits insurers, other tha