In 2023, the Legislature enacted E2SHB 1357 to modernize prior authorization processes. The law shortens prior authorization determination timelines, adds standards for clinical review criteria, and requires carriers to use certain Application Programming Interfaces (APIs) for prior authorization processes. Over time, the changes are expected to significantly reduce delays in care that occur because of prior authorization processes.
The Office of the Insurance Commissioner (OIC) has provided an implementation update and is soliciting comments to inform its upcoming report to legislators. Any comments must be submitted to Policy and Legislative Affairs on or before February 28, 2024. WSHA plans to submit comments supporting current implementation and efforts to align state and federal requirements.
The changes to prior authorization timelines and clinical review criteria apply to health plans issued on or after January 1, 2024. However, E2SHB 1357 was passed in anticipation of and prior to finalization of federal rules regarding APIs. As a result, there are some differences between the state law and federal rules to be resolved. These differences are identified in the implementation update. (Andrew Busz, andrewb@wsha.org)
