Amendment ID: S3116-54

Amendment 54

Prior Authorization Clarification

Ms. Howard and Mr. Eldridge move that the proposed new draft be amended by striking paragraph (e)(8) of section 5 and inserting in place there of the following new paragraph:-

"(8) No carrier or the group insurance commission shall require prior authorization for services included within and reimbursed through the per-member per-month payment established under the advanced primary care payment model. Services reimbursed outside of the per-member per-month payment shall remain subject to applicable coverage and utilization management requirements."