WSHA and the Washington State Medical Association are working with legislators on a bill to address the expansion of and variation in health plan prior authorization criteria. When prior authorization is improperly used, it creates delays to patient care and increases variation and administrative cost, particularly when health plans have different criteria for the same service. Prior authorization reform is one of WSHA’s top priorities for the 2020 legislative session.
The bill requires health plans submit to the Office of the Insurance Commissioner information regarding their prior authorization requirements, including approval and denial rates The bill creates a workgroup of provider and health plan clinical experts which will use the information to select specific services for recommendations regarding the need for authorization and uniform criteria. The workgroup recommendations would be adopted by the Health Care Authority and insurance carriers.
We will provide more information regarding how you can support the bill as it progresses. (Andrew Busz, AndrewB@wsha.org)