SCS/HCS/HB 1827 - This act establishes the Missouri Electronic Prior Authorization Committee in order to facilitate, monitor, and report to the General Assembly on Missouri-based efforts to contribute to the establishment of national electronic prior authorization standards. Prior authorization generally relates to the process of obtaining prior approval from an insurer for certain services or medications. Such Missouri-based efforts to be analyzed by the committee include the Missouri-based electronic prior authorization pilot program established under this act and the study and dissemination of information by the committee of the efforts of the National Council on Prescription Drug Programs (NCPDP) to develop national electronic prior authorization standards. The committee shall advise the General Assembly as to whether there is a need for administrative rules to be promulgated by the Department of Insurance, Financial Institutions and Professional Registration (Department of Insurance)as soon as practically possible.
The director of the Department of Insurance shall be chair of the committee which shall also include the director of the Department of Social Services as a member of the committee. The list of the other members to be appointed to the committee are specified under the act.
The full list of the duties of the committee are prescribed under the act but include preparing a report at the end of each calendar year to be distributed to the General Assembly and Governor with a summary of the committee's progress and plans for the next calendar year. Such annual report shall continue until such time as the NCPDP has established national electronic prior authorization standards or the provisions of this act terminate, whichever is sooner.
Upon the adoption of national electronic prior authorization standards by the NCPDP, the committee shall prepare a final report to be distributed to the General Assembly and Governor that identifies the appropriate Missouri administrative regulations, if any, that will need to be promulgated in order to make those standards effective as soon as practically possible, and advise the General Assembly and Governor if there are any legislative actions necessary to the furtherance of that end.
The Department of Insurance and the Missouri electronic prior authorization committee shall recruit a Missouri-based pharmacy benefits manager (PBM) doing business nationally to volunteer to conduct an electronic prior authorization pilot program in Missouri. The PBM conducting the pilot program shall ensure that there are adequate Missouri licensed physicians and an electronic prior authorization vendor capable and willing to participate in a Missouri-based pilot program. Such pilot program established under this act shall be operational by January 1, 2014. The department and the committee may provide advice or assistance to the PBM conducting the pilot program but shall not maintain control or lead with the direction of the pilot program.
This act contains a six-year sunset provision.
This provision is identical to a provision in SS/SCS/HCS/HB 1563 (2012) and substantially similar to SB 812 (2012).
ADRIANE CROUSE