State Legislatures Look for Ways to Improve Prior Authorization Requirements

By Consumers for Quality Care, on February 22, 2023

About 40 states are expected to consider measures that would streamline the process for doctors to obtain health plan sign-offs necessary to order procedures or treatments, Axios reports. 

In December, the Biden administration proposed rules that would create an electronic process aimed at decreasing wait times for prior authorization in Medicare Advantage, Medicaid managed care, and Affordable Care Act (ACA) exchange plans.

In 2021, an American Medical Association survey of health care providers found that a third of them reported at least one of their patients were adversely impacted because of delays caused by the prior authorization process.

State legislatures are currently exploring ways to streamline the prior authorization process, such as allowing exemptions for common requests and chronic conditions, and reducing wait times for approvals.

CQC applauds lawmakers for looking for ways to implement commonsense insurance reforms, and urges all lawmakers and providers to eliminate burdensome, unnecessary processes that prevent consumers from receiving the medical care they need.