The Journal Record: New Law Timeline for Health Insurance Prior-Authorization

May 21, 2024 | By: Jeff Elkins

An Oklahoma House bill that reforms prior-authorization procedures is set to become law next year.

House Bill 3190, known as the Ensuring Transparency in Prior Authorization Act, was signed into law last week.

The bill’s authors, state Rep. Carl Newton, R-Cherokee and Sen. Jessica Garvin, R-Duncan, worked with the Oklahoma Academy of Family Physicians on the legislation to bring more consistency, expeditiousness and transparency to the prior-authorization process and reduce administrative burdens on physicians.

The bill, which passed both chambers without a no vote, requires that prior-authorization procedures must be published on websites available to patients and providers.

Garvin said Newton has worked tirelessly on the legislation to ensure that patients and physicians are in charge and “driving their medical decisions and not insurance companies.”

Those with chronic conditions must be notified no less than 60 days prior to changes that will affect them. If a prior authorization is denied, appeals will be reviewed by providers of the same or similar specialties. Additionally, health insurers must respond to urgent requests within 72 hours and seven days for non-urgent requests.

OAFP Executive Vice President Kari Webber said family physicians are generally well-positioned to advocate for policy solutions that address burdensome administrative tasks that take time away from tending to their patients’ medical needs. She said physicians and an insurance group work with lawmakers to ensure that House Bill 3190 benefits all parties involved.

“This was just something that really came to the forefront (last year), and it started a really good conversation between ourselves and also the health insurance companies as well,” Webber said.

Webber said prior authorizations can be a burdensome process that puts patients at risk.

Reform of that process is happening across the U.S. Nine states and the District of Columbia passed laws that reform the prior-authorization process in 2023.

Transparency was mentioned during floor session votes, and Webber said that’s another key aspect of the legislation. She said insurance companies will be required to publish prior-authorization procedures on a website for enrollees and providers to have easy access.

Webber said insurance companies want the prior-authorization process to be “more useful for physicians” so the carriers don’t have to deny care. She said proper filing through an electronic system and less use of paper and a fax machine is something insurance companies were interested in.

“At the end of the day, it’s one of those things where we already know that 94% of physicians report that their care is delayed because of prior authorizations. And then 80% report that if a prior authorization is denied, then patients (might) maybe abandon that course of treatment,” Webber said. “So overall, in order to streamline this process and make it more efficient, we are looking at bettering the health of the patient in the state, which then of course, reduces costs overall for insurance.”

The law becomes effective January 1, 2025, when insurance plans start the new coverage period.