June 10, 2016

States Debate Prior Authorization Controls

At least two of the 12 legislatures still in session in the states and the District of Columbia in mid-June are considering bills that could affect prior authorization paperwork and processes.

In New Hampshire, HB 1608 would require health insurers, health maintenance organizations, health services corporations, medical services corporations and preferred provider programs to use and accept only the uniform prior authorization (PA) forms and criteria developed by the state commissioner of insurance after Dec. 31, 2017. The bill’s provisions would apply to Medicaid, including its managed care and fee-for service (FFS) payments.

The insurance department is working with managed care organizations (MCOs) to develop a single PA form for both managed care and FFS. The proposed bill allows automatic approval of a PA request if an insurer response is not received within two business days of the application, but the bill does not require providers to submit clinical documentation. As of June 6, the bill had passed both the House and Senate.

Ohio providers are optimistic about the prospects for OH SB 129. The measure, which has passed both houses, is intended to ease the burden of prior authorization for both the providers and their patients. The bill creates a more transparent and efficient prior authorization process. It would create a standard timeline for companies to respond to prior authorization requests, establish a web-based system for submission of requests and communications between providers and insurers and would also prohibit retroactive service denials after a prior authorization approval for the service has been received.