19 MAC Pt. 3, R. 19.17
Approvals for chronic conditions
Cite as 19 Miss. Admin. Code Pt. 3, R. 19.17
Approvals for chronic conditions.
(1) If a health insurance issuer requires a prior authorization for a recurring health care service
or maintenance medication for the treatment of a chronic or long-term condition, including, but
not limited to, chemotherapy for the treatment of cancer, the approval shall remain valid for the
lesser of twelve (12) months from the date the health care professional or health care provider
receives the prior authorization approval or the length of the treatment as determined by the
patient's health care professional. Notwithstanding the foregoing, a health insurer and an
enrollee or his or her health care professional may extend a prior authorization approval for a
longer period, by agreement. This section shall not apply to the prescription of benzodiazepines
or Schedule II narcotic drugs, such as opioids.
(2) Nothing in this section shall require a policy or plan to cover any care, treatment or services
for any health condition that the terms of coverage otherwise completely exclude from the
policy's or plan's covered benefits without regard for whether the care, treatment, or services are
medically necessary.