Prior Authorization Bill Clears State House Committee

September 20, 2022

Legislation to reform prior authorization and improve access to care passed the state House Insurance committee today.

This morning, the insurance committee unanimously advanced Senate Bill 225. The legislation reforms the prior authorization process to expedite approval of patient care and reduce administrative burdens for hospitals, physicians, and other health care providers.

Among the key provisions in the bill:

• Clearly defines terms for the prior authorization process
• Affirms that emergency treatment is not subject to prior authorization
• Requires insurers publish the parameters for when prior authorization is necessary, as well as the criteria used to approve or deny coverage
• Establishes timeframes in which prior authorization determinations must be completed
• Requires written documentation with specific reasons for denial decisions and instructions for how patients can appeal
• Creates a process where patients and physicians can request exceptions from step-therapy (also called “fail first”) programs
• Outlines the sharing of electronic documents between the patient, physician, and insurer which continues to protect privacy of electronic medical records

Lawmakers and stakeholders will negotiate outstanding issues and address technical clarifications as the legislation moves to the full House for consideration.

This week, HAP sent a letter to House lawmakers urging their support for the legislation.

The bill, “if amended in committee as proposed, implements legislative protections against certain payor practices and helps remove administrative barriers that burden providers, delay medically necessary patient care, result in hospital underpayments, and increase health care costs for all patients, businesses, and government payors,“ the letter said.

HAP continues to advocate for legislation at the state and federal levels to remove administrative barriers that delay patient access to care and services.

For more information, contact Heather Tyler, HAP’s vice president, state legislative advocacy; or Jolene Calla, Esq., HAP’s vice president, health care finance and insurance.