Prior authorization.

Latest bill text (Comm Sub) [PDF]


Prior authorization. Provides that a utilization review entity may only impose prior authorization requirements on less than 1% of any given specialty or health care service and 1% of health care providers overall in a calendar year. Prohibits a utilization review entity from requiring prior authorization for: (1) a health care service that is part of the usual and customary standard of care; (2) a prescription drug that is approved by the federal Food and Drug Administration; (3) medication for opioid use disorder; (4) pre-hospital transportation; or (5) the provision of an emergency health care service. Sets forth requirements for a utilization review entity that requires prior authorization of a health care service. Provides that all adverse determinations and appeals must be reviewed by a physician who meets certain conditions. Requires a utilization review entity to provide an exemption from prior authorization requirements if in the most recent 12 month period the utilization review entity has approved or would have approved at least 80% of the prior authorization requests submitted by the health care provider for a particular health care service. Repeals superseded provisions regarding prior authorization. Makes corresponding changes.


Authored by Senator Johnson T

Fiscal Outlook

Title Description Date View
Fiscal NoteFiscal Note #1: Senate Comm Sub2024-01-19 Click To View
Committee ReportSenate Committee Report2024-01-18 Click To View
Vote SheetVote Sheet January 17, 20242024-01-17 Click To View
Fiscal NoteFiscal Note #1: Introduced2024-01-11 Click To View


Date Chamber Action
2024-01-25SenateSenator Randolph added as coauthor
2024-01-22SenateSenator Niezgodski added as coauthor
2024-01-22SenateSenators Buck and Zay added as coauthors
2024-01-18SenateSenator Yoder added as coauthor
2024-01-18SenateSenator Ford J.D. added as coauthor
2024-01-18SenateSenator Donato added as coauthor
2024-01-18SenateSenators Alting and Doriot added as coauthors
2024-01-18SenatePursuant to Senate Rule 68(b); reassigned to Committee on Appropriations
2024-01-18SenateCommittee report: do pass, adopted
2024-01-16SenateSenators Walker K and Alexander added as coauthors
2024-01-16SenateSenator Leising added as coauthor
2024-01-16SenateSenator Crider added as coauthor
2024-01-16SenateSenators Busch and Koch added as coauthors
2024-01-16SenateSenator Bohacek added as coauthor
2024-01-16SenateSenator Becker added as coauthor
2024-01-16SenateSenators Baldwin and Messmer added as coauthors
2024-01-16SenateSenators Brown L and Rogers added as coauthors
2024-01-16SenateSenator Garten added as third author
2024-01-16SenateSenator Charbonneau added as second author
2024-01-16SenateFirst reading: referred to Committee on Health and Provider Services
2024-01-16SenateAuthored by Senator Johnson T