Pennsylvania prior authorization reform bill signed into law

Pennsylvania Gov. Tom Wolf on Nov. 3 signed a bill aiming to streamline the prior authorization process. 

The law requires insurers to provide timely approval for nonurgent and emergency healthcare services to physicians before services and treatment plans are rendered, according to a news release from the state Sen. Kristin Phillips-Hill's office. It also creates a timely process for appeals determinations, and if an insurer questions the necessity of a service, the law calls for a peer review by a physician from the specialty in question. It also creates an electronic portal with all prior authorizations and accompanying paperwork flowing into one site. 

The Pennsylvania Insurance Department applauded the signing, stating in a Nov. 3 news release that the law gives it authority over external reviews of benefit determinations under the ACA. For the past decade, the state has been prevented from assisting beneficiaries in a timely manner and from addressing systemic issues identified in external reviews, the agency said, adding that state oversight was preempted by the federal government. 

Regaining authority over the external review process will give the state Insurance Department the ability to help beneficiaries by "promptly responding to appeals of prior authorization denials and understanding the scope of any given insurer's adverse benefit determinations," according to the release.  

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