More Fragmented, More Complex: State Regulation of AI in Health Care

Background: Prior authorization is the requirement that a health care provider seek approval of a drug, procedure, or test before receiving reimbursement from a health carrier.Health carriers may impose different prior authorization standards and criteria for a covered service among tiers of contracting providers.In 2023, the Legislature passed HB 1357, establishing timeframes for standard and expedited prior authorization requests for health plans offered by health carriers, health plans offered to public or school employees, retirees, and their dependents, and Medicaid coverage offered through managed care organizations.