TO AMEND THE PRIOR AUTHORIZATION TRANSPARENCY ACT; AND TO CLARIFY THE PROCESS OF AN ADVERSE DETERMINATION NOTICE UNDER THE PRIOR AUTHORIZATION TRANSPARENCY ACT.

House Bill 1700, now Act 638, amends the Prior Authorization Transparency Act to clarify processes for prior authorization requests and denials. It establishes that a requested prior authorization is deemed approved if a healthcare provider submits an audio recording to the State Insurance Department demonstrating a violation by the utilization review entity. In such instances, the department must direct the entity to immediately issue the authorization. The act also clarifies that upon an adverse determination (a denial of prior authorization), the utilization review entity must provide a written notice to the subscriber.