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Health Care Groups Press for HAP-Supported Prior Authorization Reform

Yesterday, a broad coalition of doctors, hospitals, patient advocates, and others conducted a press conference to ask the state House Insurance Committee to take action on HAP-supported House Bill 1194, sponsored by Representative Stephen Mentzer (R–Lancaster). The bill would provide common sense solutions to help reduce barriers and delays to patient care by reforming the prior authorization practices of many insurers, imposing strict deadlines and curbing excesses.

Prior authorization—also known as “preauthorization,” “precertification,” “prior approval,” “prior notification,” “prospective review,” and “prior review”—is the practice of requiring a health care provider to obtain advance approval from a health plan before a specific procedure, service, device, supply, or medication can qualify for coverage by that plan when that care is delivered to the patient. It can lead to delays in patients receiving care; increased administrative burden for health care providers, which can detract from patient care; and increased health care costs for businesses, consumers, and government insurers.

Reports have shown increases in prior authorization. Survey analysis from the Workgroup for Electronic Data Interchange found that 84 percent of responding providers said the number of medical services that require prior authorization is increasing. In addition, a 2017 physician survey by the American Medical Association found:

  • Sixty-four percent of physicians reported waiting at least one business day for a prior authorization response
  • Ninety-two percent reported delays in patient care
  • Seventy-eight percent reported that prior authorization can at least sometimes lead to treatment abandonment
  • Ninety-two percent reported that prior authorization can have a negative impact on patient clinical outcomes
  • Eighty-four percent said the burden associated with prior authorization was “high” or “extremely high”
  • Eighty-six percent reported that prior authorization burdens have increased during the past five years

HAP and Pennsylvania’s hospital community believe that patient care should not be delayed because of red tape, and support efforts to reform the state’s burdensome prior authorization laws.

An audio recording of yesterday’s press conference is available. HAP has developed a fact sheet on the topic, “Reforming Prior Authorization; Protect Patient Access to Timely Care,” that outlines important information about increasing prior authorization delays and denials and the impact on quality.

For more information about prior authorization or House Bill 1194, contact Warren Kampf, HAP’s senior vice president, advocacy and external affairs.

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