Bipartisan bill to reform prior authorization draws wide stakeholder support; sets enforceable timelines and AI limits

Assembly Bill 290, a bipartisan measure to tighten and make transparent the prior authorization process used by health insurers, drew broad support and detailed stakeholder negotiation during a lengthy Friday hearing.

Sponsor Assemblymember Yuwing Wing (pronounced Yu‑wing) and co‑sponsor Assemblymember Toby Urich described the bill as the result of months of work with doctors, insurers, pharmacies and other stakeholders. Dr. Florence Jamieson, a practicing obstetrician‑gynecologist who founded the Volunteers in Medicine free clinic in Southern Nevada, described the human consequences of long prior‑authorization waits: "When we asked our patients, what challenges are you facing with your insurance? The most common response we receive overwhelmingly is prior authorization," she told the committee, adding that delays have contributed to adverse patient outcomes in national surveys.

Under the conceptual amendment presented at the hearing, AB290 would require that an initial adverse determination be made only by a licensed physician or dentist who holds an unrestricted license in any U.S. state and has relevant clinical experience for the condition under review. Before issuing a denial based on medical necessity, the insurer must offer the treating provider a live phone or video conversation with the reviewing provider. Any denial must be communicated promptly in writing with the specific reason, missing documentation identified, and clear appeal instructions. The amendment also sets response timeframes: insurers must respond to non‑urgent prior authorization requests within 7 calendar days and to urgent requests within 48 hours; if the insurer requests additional documentation within those timeframes the insurer must decide within 7 days (nonurgent) or 48 hours (urgent) after receiving the information.

The amendment further establishes that prior authorizations remain valid for six months and that prior approvals issued by a previous plan must be honored for the first 90 days after a patient changes insurance (provided the authorization was issued within the prior six months and documentation is transmitted). The bill would also require insurers to publish prior‑authorization procedures and criteria in clear, conspicuous language accessible to laypersons and to disclose whether they use artificial intelligence (AI) or automated decision tools. If AI is used in a decision, a licensed provider must independently review and affirm any adverse determination.

Health providers and nurse advocates said these reforms will reduce delays for diagnostic testing, specialist care and medication starts. "This is about restoring accountability, transparency, and critical oversight," Assemblymember Toby Urich said. Dr. Jamieson gave repeated clinical examples—including diagnostic cascades for breast cancer—where sequential prior‑authorization delays can meaningfully delay treatment.

Representatives of insurers and trade groups testified in neutral and said they supported many of the collaborative changes but raised definitional and implementation issues. Adam Plain of the Division of Insurance noted the insurance code's complexity and flagged a theoretical scenario in which reciprocal honoring of prior authorizations from another insurer could be abused; he also said state jurisdictional limits could affect whether ERISA (self‑insured employer) plans must reciprocate. The division noted it had adopted AI model bulletins and said the bill's AI language aligns with existing Division standards.

The Division of Healthcare Finance and Policy (DHCFP) said its fiscal note would be reduced to zero if the conceptual amendment is fully accepted. Sponsors said they removed provisions applying the changes to Medicaid, CHIP and Medicare Advantage from the bill to avoid triggering a substantial fiscal note and federal compliance complications; they said they would seek future inclusion after refining the approach.

Committee members asked technical questions—Assemblymember Anderson asked whether "7 days" meant calendar days; sponsors agreed to clarify the language to say "7 calendar days." Several members praised the collaborative stakeholder process. The transcript records no committee vote on AB290 at this hearing.