On September 23, the Office of the Insurance Commissioner (OIC) released a third iteration of stakeholder draft rules concerning prior authorizations. We are pleased that the OIC has undertaken a rule making process on prior authorization and is trying to provide more transparency around some of the requirements. The newest draft maintains many important provisions and protections contained in earlier drafts.
We are also pleased the newest draft includes a provision for extenuating circumstances, as requested by WSHA and other provider organizations. We are disappointed, however, that the draft does not require carriers to provide clinical and financial justification for new requirements.
WSHA is undertaking a thorough review of the stakeholder draft and will submit detailed comments prior to the due date of October 14. In addition, OIC will hear verbal comments at a stakeholder meeting scheduled for October 5. We do not know at this time if OIC plans an additional stakeholder draft or will instead submit the next set as part of the formal (CR-102) rulemaking process. (Andrew Busz, firstname.lastname@example.org)