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Senate hears bill to tighten prior‑authorization transparency, limit AI‑only denials and require peer‑to‑peer access
Summary
Senate Bill 5,395 would require carriers to include identifying information about reviewers on prior‑authorization notices, ensure peer‑to‑peer discussions are available with clinicians who can overturn denials, restrict retroactive denials, and limit use of artificial intelligence as the sole basis to deny care. Supporters said the changes would
Senate Bill 5,395, a bill to improve transparency and accountability in the prior‑authorization process, drew broad testimony Feb. 7 before the Senate Health & Long Term Care Committee.
Sponsor Tina Orwall said the bill is intended to make prior‑authorization decisions more transparent, timely and clinical. “There’s been an increased number of things requiring pre‑approval, higher claims being denied and the use of AI in some of those processes,” Orwall said, and the bill seeks to clarify procedures and guardrails so patients get timely care.
Under the draft, when a carrier issues a prior‑authorization determination the carrier must include a…
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