Majority of states looking to regulate prior authorization this year

As many as 42 states could introduce bills this year to limit or change prior authorization, Miranda Motter, AHIP's vice president of state affairs, told Axios Jan. 27. 

So far, 26 bills have been introduced in 16 states, according to the report. 

Prior authorization reforms have been targeted by states in recent years. Texas passed a "gold card" law in 2021. Under the law, physicians who have a 90 percent prior authorization approval rate over a six-month period on certain services are exempt from prior authorization requirements for those services. Rules for the law went into effect in October. 

In 2022, Louisiana and Michigan also passed gold card legislation, and others, like Mississippi, are looking to do the same this year. 

Payers have called gold cards a "mixed bag," according to a November survey by AHIP, an industry lobbying group. Forty-six percent of payers surveyed said gold cards have reduced administration burdens and improved provider satisfaction, but a third said such programs are administratively difficult to implement. In the same survey, 76 percent of payers said state regulations have negatively impacted prior authorization programs. 

New Jersey lawmakers are weighing a change to existing law to reduce the time payers can take to approve or deny a claim from 15 days to one day. Prior authorization reforms could also be handed down at the federal level this year. CMS in December issued a proposed rule it says will streamline the prior authorization process. Federal officials held a listening session with providers on the proposed rule Jan. 17.

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