§1060.13. Prior authorization; time periods
A. For any services typically covered under the plan and related to the diagnosis or
treatment of cancer for which prior authorization is required under a health coverage plan,
the health insurance issuer shall offer an expedited review to the provider requesting prior
authorization. The health insurance issuer shall communicate its decision on the prior
authorization request to the provider as soon as possible, but in all cases no later than two
business days from the receipt of the request for expedited review. If additional information
is needed and requested for the issuer to make its determination, the issuer shall
communicate its decision to the provider as soon as possible, but no later than forty-eight
hours from receipt of the additional information.
B. For any services typically covered under the plan and related to the diagnosis or
treatment of cancer for which prior authorization is required under a health coverage plan and
for which the health insurance issuer does not receive a request for expedited review from
the provider, the issuer shall communicate its decision on the prior authorization request no
later than five days from the receipt of the request. If additional information is needed and
requested for the issuer to make its determination, the issuer shall communicate its decision
to the provider no more than two business days from receipt of the additional information.
C. The provisions of this Section shall apply only when the requesting provider
clearly indicated that the request is related to the diagnosis or treatment of cancer.
D. The provisions of this Section shall not apply to non-melanomatous skin cancer.
Acts 2023, No. 254, §1.