Complete Story
06/01/2023
Senate Bill 247
Senate Bill 247
Michigan passes legislation to help alleviate frustrations with prior authorizations for pharmaceuticals, and other medical treatments. (I.e., surgery)
It is a well-known fact that submitting prior authorizations consumes a lot of staff time and creates frustration. Long processing times and denials often delay treatment plans, causing patients to endure unnecessary circumstances longer than needed.
Insurers have been using their guidelines which were not readily available and varied per contract. Also adding to the confusion was whom to submit the authorization request through the responsible party could be the payer, third party processor, or utilization reviewer depending on the type of authorization and patient contract.
Michigan signed into law Senate Bill 247. The goal of this reform is to reduce wait times and streamline interaction between physician offices and payers. This new law will help patients receive timely care. Also, the new law requires an insurer to adopt a program that promotes the modification of prior authorization requirements. This will help health care providers. Insurers are making the necessary changes with respect to adherence to nationally recognized evidence-based medical guidelines and other quality criteria.
Be sure to check with your payer as this change became effective June 1, 2023.
Here is a link the new law:
http://www.legislature.mi.gov/documents/2021-2022/publicact/pdf/2022-PA-0060.pdf
Summarization of time:
The bill states that starting June 2023, health insurers must act on urgent prior authorization requests within 72 hours (about 3 days) and non-urgent prior authorization requests within nine days, which will be narrowed to seven days by 2024
