AB50,1433,12 625.12 (2) Classification. Except as provided in s. ss. 632.728 and 632.729, risks may be classified in any reasonable way for the establishment of rates and minimum premiums, except that no classifications may be based on race, color, creed or national origin, and classifications in automobile insurance may not be based on physical condition or developmental disability as defined in s. 51.01 (5). Subject to ss. 632.365, 632.728, and 632.729, rates thus produced may be modified for individual risks in accordance with rating plans or schedules that establish reasonable standards for measuring probable variations in hazards, expenses, or both. Rates may also be modified for individual risks under s. 625.13 (2).

AB50,2917 Section 2917. 625.15 (1) of the statutes is amended to read:

AB50,1433,21 625.15 (1) Rate making. An Except as provided in s. 632.728, an insurer may itself establish rates and supplementary rate information for one or more market segments based on the factors in s. 625.12 and, if the rates are for motor vehicle liability insurance, subject to s. 632.365, or the insurer may use rates and supplementary rate information prepared by a rate service organization, with average expense factors determined by the rate service organization or with such modification for its own expense and loss experience as the credibility of that experience allows.

AB50,2918 Section 2918. 628.34 (3) (a) of the statutes is amended to read:

AB50,1434,7 628.34 (3) (a) No insurer may unfairly discriminate among policyholders by charging different premiums or by offering different terms of coverage except on the basis of classifications related to the nature and the degree of the risk covered or the expenses involved, subject to ss. 632.365, 632.728, 632.729, 632.746 and, 632.748, and 632.7496. Rates are not unfairly discriminatory if they are averaged broadly among persons insured under a group, blanket or franchise policy, and terms are not unfairly discriminatory merely because they are more favorable than in a similar individual policy.

AB50,2919 Section 2919. 628.42 of the statutes is created to read:

AB50,1434,10 628.42 Disclosure and review of prior authorization requirements. (1) In this section:

AB50,1434,11 (a) “Health care plan” has the meaning given in s. 628.36 (2) (a) 1.

AB50,1434,14 (b) 1. “Prior authorization” means the process by which a health care plan or a contracted utilization review organization determines the medical necessity and medical appropriateness of otherwise covered health care services.

AB50,1434,17 2. “Prior authorization” includes any requirement that an enrollee or provider notify the health care plan or a contracted utilization review organization before, at the time of, or concurrent to providing a health care service.

AB50,1434,18 (b) “Provider” has the meaning given in s. 628.36 (2) (a) 2.

AB50,1434,21 (2) (a) A health care plan shall maintain a complete list of services for which prior authorization is required, including services where prior authorization is performed by an entity under contract with the health care plan.

AB50,1434,24 (b) A health care plan shall publish the list under par. (a) on its website. The list shall be accessible by members of the general public without requiring the creation of any of an account or the entry of any credentials or personal information.

AB50,1435,2 (c) The list under par. (a) is not required to contain any clinical review criteria applicable to the services.

AB50,1435,10 (3) (a) A health care plan shall make any current prior authorization requirements and restrictions along with the clinical review criteria applicable to those requirements or restrictions accessible and conspicuously posted on its website to enrollees and providers. Content published by a 3rd party and licensed for use by a health care plan or a contracted utilization review organization may satisfy this subsection if it is available to access through the website of the health care plan or the contracted utilization review organization as long as the website does not unreasonably restrict access.

AB50,1435,13 (b) The prior authorization requirements and restrictions under par. (a) shall be described in detail, and shall be written in easily understandable, plain language.

AB50,1435,16 (c) The prior authorization requirements and restrictions under par. (a) shall indicate all of the following for each service subject to the prior authorization requirements and restrictions:

AB50,1435,18 1. When the requirement or restriction began for policies issued or delivered in this state, including effective dates and any termination dates.

AB50,1435,20 2. The date that the requirement or restriction was listed on the website of the health care plan or a contracted utilization review organization.

AB50,1435,21 3. The date that the requirement or restriction was removed in this state.

AB50,1435,23 4. A method to access a standardized electronic prior authorization request transaction process.

AB50,1436,2 (4) Any clinical review criteria on which a prior authorization requirement or restriction is based shall satisfy all of the following:

AB50,1436,4 (a) The criteria are based on nationally recognized, generally accepted standards except where provided by law.

AB50,1436,6 (b) The criteria are developed in accordance with the current standards of a national medical accreditation entity.

AB50,1436,8 (c) The criteria ensure quality of care and access to needed health care services.

AB50,1436,9 (d) The criteria are evidence-based.

AB50,1436,11 (e) The criteria are sufficiently flexible to allow deviations from current standards when justified.

AB50,1436,13 (f) The criteria are evaluated and updated when necessary and no less frequently than once every year.

AB50,1436,16 (5) No health care plan may deny a claim for failure to obtain prior authorization if the prior authorization requirement was not in effect on the date that the service was provided.