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Committee advances bill to require insurers to report preauthorization outcomes and reasons
Summary
SB 274 would require insurers to publish annual counts of preauthorization approvals, denials and approvals on appeal and to explain denials to patients; the committee favorably recommended the bill after sponsor said transparency should change insurer behavior.
The House Health and Human Services Committee voted to favorably recommend SB 274, a bill requiring health insurers to report annually the percentage of preauthorization requests that were approved, denied and approved after appeal, and to provide detailed denial explanations to patients.
Sponsor Senator Johnson said the measure was brought to him by a constituent whose son — who uses a wheelchair — was denied a replacement chair after a preauthorization denial, and that transparency would encourage insurers to provide clearer reasons for denials. “Sunlight is the best disinfectant,” the sponsor told the committee.
Under the substitute discussed in committee, an insurer must also explain the specific information missing when a request is denied for lack of documentation, and provide instructions on how to appeal. Representative Ward asked whether the reporting requirement should have a sunset review so the committee can reassess whether the data are useful; Senator Johnson said he would be open to a sunset provision and that House sponsor Representative Hall was preparing a substitute.
Committee members also discussed funding for the reporting requirement; Senator Johnson said he had made the reporting requirement a priority for available senate funds and expected it to be low‑cost.
Ending — The committee voted to favorably recommend SB 274 to the House floor.
