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Legislature passes prior authorization reform for medical procedures, drugs

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Legislature passes prior authorization reform for medical procedures, drugs

Feb 20, 2024 | 3:35 pm ET
By Taylor Vance
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Legislature passes prior authorization reform for medical procedures, drugs
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Photo courtesy of Mississippi Today

The Legislature has overwhelmingly passed a bill to regulate how insurance companies decide which prescription drugs and medical procedures to cover for a consumer — a process called prior authorization.

The Senate passed the proposal unanimously earlier this month, but the House had amended the Senate bill and sent it back. The Senate on Tuesday agreed to the House’s changes. 

The proposal now heads to Republican Gov. Tate Reeves, who vetoed a similar measure last year, for consideration. 

“The bill that we have will be a great improvement for the process,” Senate Insurance Committee Chairman Walter Michel said. “It’s great for the medical community, it’s great for the patient, and it’s an improvement for the insurance companies as well because they have a defined timetable to provide the prior authorization.”

Prior authorization is when physicians have to seek approval from an insurance company before the company will cover a prescribed procedure, service or medication that is not an emergency.

If an insurance organization denies a prior authorization claim, a consumer could be forced to pay for a prescription or medical procedure out of pocket. 

Insurance companies typically believe prior authorization helps ensure doctors provide only medically necessary services. Doctors argue the process is typically handled by clerical insurance staffers ill-equipped to understand medical procedures. 

The bipartisan proposal would require insurance companies to create a “portal” or website by January 2025 for doctors to submit prior authorization applications.

For emergency services such as treating a stroke, prior authorization is not required under the new measure. For urgent services or procedures that can help treat someone in intense pain, insurance companies have 48 hours to process requests. For non-urgent services, insurance companies have seven days to process requests. 

The governor vetoed a similar measure last year, but a Reeves spokesperson previously told Mississippi Today that the governor’s office has worked with “necessary stakeholders” to address some of his concerns in last year’s version of the bill. 

“We made changes mainly to hopefully find something that the governor can agree with and go on and sign into law,” House Public Health Chairman Sam Creekmore IV said. “I think they were reasonable changes, and I hope it will make for a more efficient prior authorization process going forward.” 

Insurance Commissioner Mike Chaney’s office will be responsible for enforcing the plan, and Michel told reporters on Tuesday that he intends to ask legislative leaders to give more money to Chaney’s office to effectively enforce the program.