Committee approves measures to tighten clinical review and limit prior authorization for tribal behavioral‑health services
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Summary
The committee advanced two related bills: SB 11‑16 requires appeal reviews for behavioral‑health claim denials to be conducted by clinicians with relevant experience; SB 11‑22 prevents Access from requiring prior authorization for services delivered under the American Indian Health Plan except under corrective‑action conditions.
Members advanced two bills aimed at correcting administrative barriers in behavioral‑health claims.
SB 11‑16, as amended, requires that appeals or denials based on medical necessity for behavioral‑health services be reviewed by an individual with at least two years of relevant clinical experience providing the same or similar services. Sponsors framed the change as a fix to mismatched clinical review, citing examples where pediatricians or emergency physicians previously reviewed behavioral‑health claims.
SB 11‑22 prohibits Access (Arizona Health Care Cost Containment System) from requiring prior authorization for behavioral‑health services provided to members under the American Indian Health Plan, while allowing prior authorization if a corrective action plan is implemented and compliance is not achieved.
Access and other stakeholders testified neutral on SB 11‑16, warning that the statutory phrasing of "relevant clinical experience" needs definition and could create FTE or compliance burdens; sponsors said floor amendments would clarify definitions and aim to use behavioral‑health professionals for reviews. Both measures drew supportive testimony emphasizing provider sustainability and faster payment for services.
The committee adopted amendments and gave both bills due‑pass recommendations.
