Missouri Republican state Sen. Benjamin Brown introduced a bill Jan. 7 to slash prior authorization requirements for providers.
Providers would be exempt from prior authorization unless the insurer or party carrying out utilization review determined that less than 90% of requests in the most recent evaluation period were approved or would have been approved.
Health carriers would inform providers within 25 days of their evaluations, establishing an appeals protocol and maintaining an online portal. The bill also keeps health carriers from denying or lowering payments to providers with prior authorization, except for specific circumstances.
The bill would not apply to Missouri Medicaid services provided outside a managed care organization and providers who have not engaged with a health plan for at least one full evaluation period.
If passed, the legislation would go into effect Aug. 28.
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