OIC Begins Process on 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 current draft increases accountability for benefit managers and third party administrators and clarifies how health plans must notify providers of new services requiring prior authorization. WSHA would also like to see added requirements that any new prior authorization requirements are medically and financially justified, and put in place an allowance for exemptions from prior authorizations if the patient is facing extenuating circumstances.

The Washington State Medical Association and many of our members have been asking the OIC to more carefully regulate this process. Stakeholder comments are being received at an in-person meeting on August 10 and in written form through August 17.

You can also share your thoughts with us, as WSHA will also submit 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)


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