Published in Health Care

State lawmakers advance reforms to speed up health care prior authorization process

BY Friday, March 18, 2022 04:20pm

LANSING — Legislation to reform the process when physicians and hospitals seek prior authorization from health insurers for patient care cleared another hurdle toward eventual passage.

The state House Health Policy Committee on Thursday advanced Senate Bill 247 that previously passed the state Senate. The bill would modify an existing state law over prior authorization requests by including time limits on a health insurer’s response to a request.

“Health really can’t wait, and it’s encouraging to see this committee agree with that sentiment. With the bill now on its way to the full House for consideration, we look forward to the next steps in working to protect patients’ access to the care they need,” said Pino Colone, president of the Michigan State Medical Society, which has been advocating for prior authorization process reforms.

The Medical Society  — working through the Health Can’t Wait coalition of health care providers and patient advocates — argues that prior authorization has expanded from requirements on higher-cost procedures, tests and medications to now affecting routine medical services.

Under S.B. 247, health insurers initially would have nine calendar days beginning Jan. 1, 2023 to grant or deny a prior authorization request for non-urgent care before it’s considered granted. That timeline would drop to seven calendar days after Dec. 31, 2023. Health insurers also would have to grant or deny urgent care requests within 72 hours of submission.

The timelines included in the legislation would begin once a physician has submitted all of the information that a health insurer needed to review a prior authorization request.

S.B. 247 also would require physicians to submit prior authorization requests to insurers electronically in a standardized format that should speed up the process, and sets criteria for appeals and requires insurers to base decisions on “peer-reviewed” clinical standards.

The legislation “really recognizes the need for quick prior approvals for urgent and time-sensitive procedures,” said Adam Carlson, senior vice president for advocacy for the Michigan Health & Hospital Association, which strongly supports the bill. “It puts those hard timeframes around the prior authorization process to make sure that paperwork is not slowing down the care for patients. At the end of the day, we want to make sure that health care does not wait for paperwork that we’re doing and for what’s in the best interests for patients.”

Sponsored by Sen. Curt VanderWall, R-Ludington, the legislation moved through the House committee after lawmakers, insurers and advocates who seek to rein in prior authorization worked out a compromise.

The Senate unanimously passed S.B. 247 in March 2021. The bill now awaits a vote in the full House.

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