On Thursday, April 22, the Senate Health Policy and Human Services Committee unanimously passed Senate Bill 247, legislation that reforms the prior authorization practices insurance companies use to slow the delivery of life saving health care. The bill passed by a vote of eight yeas, zero nays, and two passes, and will now move on to the full Senate for consideration.
“We applaud the Senate Health and Human Services committee for passing SB 247 today, moving Michigan one step closer to the kind of meaningful prior authorization reform our state’s patients and providers need," said S. Bobby Mukkamala, MD, President of the Michigan State Medical Society. "Health really can’t wait, and it’s encouraging to see this committee agree with that sentiment. If passed, SB 247 will go a long way towards reducing costly and dangerous delays in accessing health care. We hope the rest of the Senate recognizes the tremendous value in that and takes the necessary next steps with this important legislation.”
A substitute version of the bill was also adopted in committee that made minor changes to the timeline insurers are required to respond by. Most notably, for non-urgent requests, beginning January 1, 2023 through December 31, 2023, a prior authorization request is considered granted if the insurer fails to grant the request, deny the request, or request more information within 7 business days of the original submission. After December 31, 2023, a prior authorization request is considered granted if the insurer fails to grant the request, deny the request, or request more information within 5 business days of the original submission.
Senate Bill 247 introduces new requirements to the prior authorization process, which include:
- Transparency: Insurance company prior authorization requirements will be published on the insurer’s website in detail and in easily understandable language, and that aggregated information about prior authorization approval and denials are made publicly available.
- Clinical validity: Clinical review criteria is based on current peer-reviewed evidence and individuals with a financial stake in the outcome of prior authorization decisions are prohibited from the decision-making process.
- Fairness for patients: Urgent and non-urgent prior authorization requests must be acted upon in a timely manner and clinicians and patients are properly notified of new or amended prior authorization requirements.
The bill would also require insurers to base their prior authorization requirements on clinical, evidence-based criteria established with input from practicing physicians.