On Tuesday, WSHA staff testified at an Office of the Insurance Commissioner stakeholder hearing concerning the latest stakeholder draft rules regulating alternative authorization processes, referred to as “goldcarding. Specifically, WSHA urged the OIC to use a more generic term for the process and make clear that the definition excludes risk-based arrangements that include delegated utilization management. We expect this to be corrected in the next draft of the rule. WSHA also testified that requirements for the description of the program should not be excessively detailed, to avoid excessive burden on carriers and providers that might hinder adoption of the processes. Lastly, we requested the hold harmless provisions in the draft be clarified to exclude services denied due to benefit exclusion, such as cosmetic surgery.
WSHA strongly supports alternate authorization processes, as they have the potential to reduce cost and administrative burden for carriers and providers and avoid delays in patient care that occur under standard prior authorization processes. WSHA is in the process of drafting its written comments on the stakeholder draft, which are due October 10. Please let Andrew Busz know if you would like a copy of our comments. (Andrew Busz, firstname.lastname@example.org)