Laws in North Dakota, Nebraska and Alaska focused on accelerating insurer response times for prior authorizations went into effect Jan. 1.
North Dakota Gov. Kelly Armstrong signed the state’s bill in April. The legislation requires plans to decide on nonurgent prior authorization requests within seven calendar days and urgent care requests within 72 hours. Otherwise, services will be deemed approved.
Nebraska’s law establishes similar response timelines. However, starting in 2028, insurers will have only up to 48 hours to review urgent requests.
Alaska’s law demands even more speed, requiring payers to update patients on their prior authorization decision within 72 hours for routine cases or 24 hours for expedited ones.
CMS prior auth rules from 2024 were also slated to take effect this year, with 72-hour and seven-day response time frames for Medicaid and Medicare Advantage plans.
“The most important thing is speed,” CMS Administrator Mehmet Oz, MD, said during an industry conference in October. “It’s infuriating to be anxious about an illness while waiting for someone not directly involved in your care to approve what’s appropriate.”
Related Illinois legislation — containing elements going into effect in both 2025 and 2026 — did not set new timelines for prior authorization. However, it did require insurers to report on the timing of responses, and included directory and network adequacy reforms. As of Jan. 1, Illinois maintains prior authorization bans on inpatient psychiatric admissions and outpatient mental health services, as well.
