WISCA members shared an interest in monitoring prior authorization policy changes in the state. The following is a summary of recent developments:
1) The State’s Joint Committee on Finance recently met to review budget items included in Governor Ever’s state budget. On May 8 they voted on party lines to remove what were considered “policy” items from the budget. These include 2 proposals from the Office of the Commissioner of Insurance.
- The first would have authorized the Insurance Commissioner to provide, by administrative rule, that any health benefit plan or self-insured health plan that uses a prior authorization process shall exempt health care providers from obtaining prior authorizations for a health care item or service for a period of time established by the Commissioner if, in the most recent evaluation period, the health benefit plan or self-insured health plan has approved or would have approved a proportion of prior authorization requests submitted by the health care provider for the health care item or service that is not less than a benchmark threshold specified by the Commissioner.
- The second proposal would have specified the clinical review criteria used by any health care plan for any prior authorization requirement or restriction must: (a) be based on nationally recognized, generally accepted standards except where provided by law; (b) be developed in accordance with the current standards of a national medical accreditation entity; (c) ensure quality of care and access to needed health care services; (d) be evidence-based; (e) be sufficiently flexible to allow deviations from current standards when justified; and (f) be evaluated and updated when necessary and no less frequently than once every year.
2) Assembly Health Committee Chair Clint Moses (R-Menomonie) announced at plans to introduce legislation that would reform prior authorization process in the state. His goals are to have greater consistency among insurers, speed up the process in order to prevent any care delays and reduce provider burdens.
