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Committee hears wide support and insurer concerns for prior‑authorization reform bill
Summary
Rep. Jonathan Karlen told the House Business and Labor Committee that House Bill 398 would require continuity of prior‑authorization decisions when patients switch plans, specialty‑matched reviewers for clinical denials, and longer authorization periods for chronic care.
Representative Jonathan Karlen opened the committee hearing on House Bill 398, which he described as a negotiated effort to reduce delays and administrative burdens associated with prior authorization while preserving patient safety.
Major provisions in the bill and sponsor amendment include: honoring existing prior authorizations for at least three months when a patient changes insurance plans; requiring that adverse (denial) determinations be made by a reviewer with clinical expertise focused on the diagnosis and treatment at issue; extending standard prior‑authorization approvals from three to six months and, for defined chronic conditions, to 12 months; and defining ‘‘chronic condition’’ by reference to the Centers for Disease Control and Prevention (CDC) definition.
Why it matters: Physicians and hospital advocates told the committee the current prior‑authorization…
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