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Senate panel advances bill to standardize prior-authorization windows and online transparency
Summary
A Senate committee voted to report SB 1215, a bill to require clearer time limits and online disclosures for prior authorization requests, after sponsors and health plans reached a substitute both sides said they negotiated.
Senate lawmakers voted to report SB 1215 on a substitute that sets deadlines and online transparency rules for health-insurance prior-authorization requests.
Sponsor Senator Linda Pokarski, speaking to the committee, said the substitute clarifies an expedited request and prohibits carriers from revoking prior authorization after care has been scheduled or provided, except where the authorization was obtained by fraud or the service is removed from the market. The substitute sets time frames for responses — 72 hours for expedited requests and seven calendar days for regular requests — and applies the same windows when carriers request supplemental information.
The substitute approved by the committee removes certain federal-data reporting items that did not align with federal requirements and adds an exemption for some health organizations in the prescription-drug prior-authorization section. Pokarski said the bill codifies existing federal rules in state law and aims to reduce administrative delays that can stall patient care.
Julie Dye of the Virginia Hospital & Healthcare Association told the committee the bill reflects broad agreement between hospitals and health plans after last-minute stakeholder work. No organized opposition spoke at the committee; the vote tally on the committee machine was recorded as 15–0 in favor of reporting the substitute to the next step.
SB 1215 will go to the next referral (committee staff and docketing show it will be referred to the standing committee identified on the roll). Supporters said the changes will make it clearer for providers what codes and services need prior authorization and when a patient will receive a determination. Opponents did not appear before the committee during this hearing.
The committee hearing included brief public testimony from clinicians and plan representatives who said the bill will reduce delays and make the process less opaque for patients and clinicians.
The committee’s action does not change the federal timelines that apply to carriers; instead, it sets state-level expectations and website disclosure requirements for carriers doing business in Virginia.
SB 1215 now moves forward per the committee’s report vote; it will be scheduled for the next committee to which it is referred.
