HB0076 • 2025

Prior authorization-amendments.

AN ACT relating to the insurance code; requiring prior authorization adverse determinations to be determined by Wyoming-licensed health care providers; requiring prior authorization appeals to be reviewed by Wyoming-licensed health care providers; specifying applicability; and providing for an effective date.

Healthcare

Inactive

Wyoming marks this bill as inactive, which usually means it is no longer moving in the current session.

Sponsor: Representative Brown, L
Last action: 2025-03-03
Official status: inactive
Effective date: 3/1/2025

Plain English Breakdown

The bill's status is marked as inactive and it died in committee on March 3, 2025.

Changes to Health Insurance Prior Authorization

The bill requires health insurance prior authorization decisions and appeals in Wyoming to be handled by licensed healthcare providers within the state.

What This Bill Does

Requires that all adverse determinations for prior authorizations must be made by a Wyoming-licensed healthcare provider.
Specifies that all appeals of these prior authorization decisions must also be reviewed by Wyoming-licensed healthcare providers.
Limits applicability to cases where prior authorization adverse determinations are made or appealed on or after July 1, 2025.

Who It Names or Affects

Health insurance companies in Wyoming
Utilization review entities that work with health insurers in Wyoming

Terms To Know

Prior Authorization: A process where a healthcare provider needs approval from an insurance company before providing certain medical services.
Adverse Determination: When an insurance company denies or limits coverage for a requested service, treatment, or supply.

Limits and Unknowns

The bill only applies to prior authorization decisions and appeals made on or after July 1, 2025.
It does not specify what happens if there are no Wyoming-licensed healthcare providers available for a specific case.

Bill History

2025-03-03 House
H:Died in Committee Returned Bill Pursuant to HR 5-4
2025-02-07 House
H No report prior to CoW Cutoff
2025-01-15 House
H Introduced and Referred to H10 - Labor
2025-01-02 House
H Received for Introduction
2024-12-24 LSO
Bill Number Assigned

Current Bill Text

Read the full stored bill text

25LSO-0555
2025
STATE OF WYOMING
25LSO-0555
Introduced
2.0

HOUSE BILL NO. HB0076

Prior authorization-amendments.

Sponsored by: Representative(s) Brown, L, Clouston, Geringer, Styvar and Wylie and Senator(s) Brennan

A BILL

for

AN ACT relating to the insurance code; requiring prior authorization adverse determinations to be determined by Wyoming-licensed health care providers; requiring prior authorization appeals to be reviewed by Wyoming-licensed health care providers; specifying applicability; and providing for an effective date.

Be It Enacted by the Legislature of the State of Wyoming:

Section 1
.

W.S. 26
‑
55
‑
104(a)(iii) and 26
‑
55
‑
106(a)(iii) are amended to read:

26
‑
55
‑
104.

Persons qualified to make adverse determinations.

(a)

Each health insurer or contracted utilization review entity shall ensure that all adverse determinations are made by a physician or other appropriate licensed health care provider who has:

(iii)

Unless otherwise required under Wyoming law, a current and unrestricted license to practice within the scope of their profession in
a state, territory, commonwealth of the United States or the District of Columbia
Wyoming
;

26
‑
55
‑
106.

Requirements applicable to persons reviewing appeals.

(a)

Each health insurer or contracted utilization review entity shall ensure that all appeals of adverse determinations are reviewed by a physician or other appropriate licensed health care provider who has:

(iii)

A current and unrestricted license to practice within the scope of their medical profession in
a state, territory, commonwealth of the United States or the District of Columbia
Wyoming
;

Section 2.

This act applies to prior authorization adverse determinations made or appealed on or after July 1, 2025.

Section 3.

This act is effective July 1, 2025
.

(END)

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HB0076