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Panel approves tighter timelines and transparency rules for prior authorization requests
Summary
The subcommittee reported a substituted prior authorization reform bill to the full committee by a vote of 6‑0. The substitute sets 72‑hour timeframes for urgent prior‑authorization responses and 7‑day windows for standard requests, requires advance notice of changes and precludes retrospective denial absent fraud or other narrow exceptions.
Delegate Maldonado presented a substitute for a prior authorization reform bill, explaining the measure would set statutory response timelines and increase transparency around prior authorization requirements for many commercial plans.
Nut graf: Lawmakers and stakeholder groups said prior authorization delays are increasingly common and can delay care; the substitute sets timelines (72 hours for expedited/urgent prior authorizations and 7 calendar days for standard requests), prohibits retroactive denials unless an authorization was obtained fraudulently or a drug/service has been removed or has new safety concerns, and requires carriers to notify providers of changes at least 30 days in advance.
Supporters from the Virginia Hospital and Healthcare Association and the Virginia Association of Health Plans said they worked together on the substitute; health plans noted federal electronic prior authorization standards for pharmacy are forthcoming and asserted this bill is a step toward broader electronic prior authorization systems. Testimony emphasized that the bill would not apply to Medicaid, Medicare, TRICARE, or certain HMOs and includes narrow carve‑outs.
Outcome: The subcommittee adopted the substitute and reported it (6‑0). Delegate Maldonado and stakeholders framed the measure as an initial step toward reducing administrative delays while enabling a future move to electronic prior authorization.
Ending: The bill advances to the next committee for further consideration; stakeholders said they would continue to coordinate implementation details and follow federal timelines for electronic prior authorizations.
