The National Council of Insurance Legislators adopted the Prior Authorization Reform Model Act sponsored by a Mississippi state senator at the group’s annual meeting.
“The model will protect the provider-patient relationship from unnecessary third-party interference, prevent programs from hindering the independent medical judgment of physicians and other healthcare providers, and ensure transparency as well as a fair and consistent process for providers and their patients,” a Dec. 11 news release said.
Some provisions include health insurers maintaining a list of services requiring prior authorization, increasing accessibility for clinical review criteria, sharing statistics on approvals and denials, leveraging a standardized electronic prior authorization process, ensuring expedited requests take less than one day to settle, offering more robust information on adverse determinations, ensuring physician review of appeals and reporting trend data.
The council said those involved in the drafting and deliberation heard from AHIP, the Blue Cross Blue Shield Association and Elevance Health, along with other interested parties in healthcare.
NCOIL CEO Will Melofchik said the legislation will serve as “important guidance for states.”
