Michigan lawmakers pass legislation reforming prior authorization process

The Michigan Legislature passed a bill March 24 that aims to reform the state's prior authorization process.

The Health Can't Wait Act, or Senate Bill 247, introduces new requirements for payers:

  • Prior authorization requirements from payers must be published on the payer's website in detail and in easily understandable language. Aggregated information about prior authorization approval and denials must also be made publicly available.
  • Clinical review criteria is based on current peer-reviewed evidence. Individuals with a financial stake in the outcome of prior authorization decisions are prohibited from the decision-making process.
  • Urgent and nonurgent prior authorization requests must be acted upon in a timely manner. Clinicians and patients must be properly notified of new or amended prior authorization requirements.

The bill also requires payers to base their prior authorization requirements on clinical, evidence-based criteria established with input from practicing physicians.

The bill was passed in the Michigan Senate in April 2021. It now awaits final signature from Gov. Gretchen Whitmer.  

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