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 Housing

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 official source does not provide specific details about applicability dates beyond the effective date of July 1, 2025.

Changes to Health Insurance Prior Authorization Rules

The bill changes the rules for health insurance prior authorization in Wyoming by requiring that adverse determinations and appeals be reviewed only by licensed healthcare providers within Wyoming.

What This Bill Does

Requires health insurers or contracted utilization review entities to ensure all prior authorization adverse determinations are made by Wyoming-licensed health care providers.
Requires health insurers or contracted utilization review entities to ensure all prior authorization appeal reviews are conducted by Wyoming-licensed health care providers.

Who It Names or Affects

Health insurance companies in Wyoming
Individuals seeking prior authorization for medical treatments or procedures

Terms To Know

Prior Authorization Adverse Determination: A decision by an insurer that denies coverage for a requested treatment or procedure.
Utilization Review Entity: An organization contracted by health insurers to review medical necessity and appropriateness of treatments.

Limits and Unknowns

The bill does not specify what happens if there are no Wyoming-licensed providers available for a specific type of treatment.
It is unclear how this change will affect out-of-state patients seeking care in Wyoming.
This bill was marked as inactive, meaning it did not pass during the current session.

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
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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