B25-0124 – District of Columbia

Status: Enacted
Year Introduced: 2023
Link: https://lims.dccouncil.gov/Legislation/B25-0124

As introduced, Bill 25-124 would regulate the practice of health insurers that require patients and their medical providers to seek prior authorization for certain medications, medical procedures, or other medical care. It would set explicit timelines for insurers to respond to prior authorization requests and appeals and establishes what qualifications personnel must have to make these determinations. It would also clarify how insurers are to make information on prior authorization determinations available to patients and their medical providers. It would also prohibit insurers from requiring prior authorization for a treatment based solely on cost and require employers to provide timely notice to employees of medications and treatments covered under their insurer’s standard health benefit plan. FUNDING NOTE – This bill is passed Subject to Appropriations. Please see the Fiscal Impact Statement (FIS) for more information.

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