WSHA Comments to OIC Regarding Prior Authorizations

July 7, 2016

On June 28, WSHA testified at a meeting convened by the Office of the Insurance Commissioner (OIC) regarding potential rulemaking on health plan prior authorizations.  In its comments WSHA requested that OIC require plans to make available to providers criteria used to determine medical necessity for prior authorizations and better integrate authorizations provided through plan-contracted benefit managers and other entities. WSHA also requested more clarity regarding plan responsibilities when services need to be provided more quickly than can be accommodated by the plan’s prior authorization processes, and that plans should be required to demonstrate the need and benefit of any new requirements.  WSHA’s complete comments can be read here.

At the meeting, a number of WSHA member hospitals and other provider groups also testified in favor of rules that would better streamline provision and authorization for services. Health plans commented that prior authorizations are necessary to ensure services are safe, effective, and necessary, and are used by plans to better manage the care of patients.

The next steps are for OIC staff to create and distribute a set of draft rules for comment by stakeholders, including providers, consumer groups, and health plans. The stakeholder draft will be followed by proposed rules as part of the official rulemaking process.  Thanks to all of our members who supported WSHA and provided written and verbal comments on this important issue! (Andrew Busz,


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