Part 2: Unpacking Prior Authorization Reform
June 25, 2021
During the Spring Legislative Session in Springfield, the General Assembly unanimously approved the Prior Authorization Reform Act (House Bill 711)! This top ISMS initiative requires that substantive and important changes be made to insurer prior authorization (PA) practices.
Physician Advocate is taking a deep dive into the various components of this important legislation. This week’s focus is timelines for urgent and nonurgent care.
Part 2: How Does the Prior Authorization Reform Act Address Timelines?
The current problem: Doctors may have to wait weeks before utilization review organizations respond to their PA requests, causing unnecessary delays in patient care.
How House Bill 711 helps: It standardizes response times by requiring utilization review organizations to respond to PA requests within specific timeframes.
- Nonurgent care: Utilization review organizations would be required to respond to prior authorization requests for nonurgent services within five calendar days of receiving all the necessary information.
- Urgent care: Utilization review organizations would be required to:
- Respond to prior authorization requests for urgent services within 48 hours of receiving all the necessary information.
- Establish a mechanism to ensure healthcare professionals have timely access to someone able to make prior authorization decisions related to urgent care services.
If you missed Part 1 on transparency, you can read it here.
Questions? Please contact ISMS Senior Vice President of Legislative Affairs Erin O'Brien by email.
Watch for next week’s topic related to the Prior Authorization Reform Act – adverse determinations.