Committee backs bill creating exemption path from prior authorization for high-approval providers

The committee issued a due-pass recommendation on House Bill 461, which creates a process by which health-care providers can seek an exemption from prospective prior-authorization requirements if they meet high approval standards over a defined evaluation period.

Sponsor testimony described prior authorization as a bureaucratic burden that delays care. Under the bill, a provider who achieves a 90% or higher approval rate on prior-authorization requests for outpatient services during a six-month evaluation period could apply for an exemption from future prior-authorization requirements for outpatient services. Insurers would retain audit rights and could revoke an exemption for suspected fraud, waste, or abuse. The sponsor said the bill was amended to exclude pharmaceuticals from the exemption and focus the measure on diagnostic tests, imaging, surgeries and procedures.

Representatives of the New Mexico Medical Society testified in support, describing the bill as a member-driven priority to reduce administrative time and free clinicians to treat patients. Committee members expressed interest in the bill’s performance-based approach; one member suggested that if the pilot succeeded, a broader change could be considered later. The committee adopted the amended language and reported the bill out on a due-pass vote. The transcript records a due pass announcement; the numeric roll-call was not printed in the excerpt used here.

Proponents said the bill aims to balance insurer oversight with clinical decision-making and to provide data to evaluate whether prior-authorization burdens can be reduced for dependable providers.