OIC Begins Process to More Carefully Regulate Prior Authorization Rules

August 4, 2016

The Office of the Insurance Commissioner (OIC) recently released a stakeholder draft of rules pertaining to prior authorizations, the first step in the rule making process.  WSHA, WSMA, and many of our members have been asking the OIC to more carefully regulate this process in order to reduce administrative overhead for providers.  OIC will be accepting comments on the stakeholder draft through August 17, 2016 and will also receive verbal comments at an in-person meeting on August 10.  The OIC plans several iterations of the stakeholder draft prior to the formal rule process.

The current draft increases accountability for benefit managers and third party administrators contracted by health plans. It also clarifies how health plans must notify providers of new services requiring prior authorization. There are several elements not included in the draft, however, that WSHA would like to see added.  These include requiring that any new prior authorization requirements are medically and financially justified, and allowing for exemptions from prior authorizations in extenuating circumstances.  We would like to see these addressed in subsequent drafts.  The draft also does not require plans to disclose the criteria that insurers use to determine if a prior authorization will be approved or denied. WSHA appreciates the Commissioner’s willingness to draft rules regarding prior authorizations. We plan to submit detailed comments throughout the process and we encourage WSHA members to comment as well.  Please let us know your thoughts so we can reflect them in our comments.

A copy of the CR-101 and initial comments previously submitted to the OIC are available here, including comments submitted by WSHA. (Andrew Busz, andrewb@wsha.org)


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