March 10, 2023
WSMA Prior Authorization Bill Approved Unanimously by House
On Saturday, the state House of Representatives took action on WSMA's priority legislation to modernize and standardize insurance carriers' prior authorization practices. House Bill 1357 was approved unanimously by the House, with several legislators giving speeches to share their personal experiences with prior authorization, as well as acknowledging the burden it represents for patients and physicians.
In its current form, HB 1357 represents the product of extensive negotiations with the state's insurance carriers. If passed into law, the bill will expedite turnaround times for prior authorization and make our state a leader in facilitating prior authorization processes that integrate into physicians' electronic medical record systems. Importantly, the bill applies not only to health care services but also to prescription drugs and will be effective for all state-regulated health plans.
Prior authorization determination timelines
HB 1357 establishes expedited turnaround times for all prior authorizations, including those for prescription drugs. The timelines for carrier determinations of prior authorizations break down into two categories, depending on whether the prior authorization is submitted electronically (e.g., via integrated prior authorization systems or carrier web portals) or non-electronically (e.g., via fax):
- Electronic prior authorizations
- Expedited: one calendar day to approve
- Standard: three calendar days to approve
- Non-electronic prior authorizations
- Expedited: two calendar days to approve
- Standard: five calendar days to approve
Electronic prior authorization systems
Building on a proposed rulemaking from the Centers for Medicare and Medicaid Services, HB 1357 mandates that carriers have automated electronic prior authorization systems that integrate into physicians' electronic medical records for health care services by Jan. 1, 2025. By Jan. 1, 2027, carriers must have the systems in place for prescription drugs.
Office of the Insurance Commissioner prior authorization reporting
Prescription drugs are added as a category of reporting of carriers' prior authorization practices, to be included in future iterations of the OIC's annual prior authorization report.
The WSMA is appreciative of Rep. Tarra Simmons (D-Bremerton) for introducing HB 1357 and her leadership on this important issue. Rep. Simmons has repeatedly referenced her past work around prior authorization as a registered nurse, including a stint working for an insurance carrier, in informing her interest in expediting the process for patients and physicians.
What's next? HB 1357 now moves to the Senate for further consideration, where WSMA will urge its approval.