SB 0666 – Tennessee

Status: Enacted
Year Introduced: 2024

The key objective is enhancing and solidifying standards for utilization review, increasing cooperation between healthcare providers and utilization review agents, and ensuring adherence to the Prior Authorization Fairness Act. The bill also mandates health insurers to comply with the Prior Authorization Fairness Act. Utilization review involves evaluation of the necessity, appropriateness, and efficiency of healthcare services and treatment plans. Prior Authorization is a requirement that physicians obtain approval from a health insurer before prescribing a medication, treatment, or service to a patient. The bill sets out comprehensive definitions important for understanding the parameters of the act, including definitions for “Chronic condition”, “Healthcare prescriber”, and “Healthcare service”, among others. Moreover, the bill details appeals processes for adverse determinations, specifications for prior authorization submissions, condition stipulations for chronic conditions, and sets expiration dates for prior authorizations. Additionally, it addresses special regulations for patients with opioid use disorders and lays out statistical requirements on how health carrier or utilization review organizations function. Overall, the bill aims to streamline the healthcare process, improve the fairness of authorizations, and enhance the healthcare provider and payer relationship.

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