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Kansas committee hears patient and physician accounts as bill seeks to tighten prior authorization
Summary
Physicians, patients and insurers gave sharply different testimony Wednesday on Senate Bill 330, which would standardize prior authorization processes, require electronic portals, set timelines and limit some retrospective denials; insurers warned of vague definitions and implementation costs.
The Kansas Senate Committee on Financial Institutions and Insurance heard hours of testimony Wednesday on Senate Bill 330, a measure intended to increase transparency and set new limits on prior authorization for health care and pharmacy benefits.
The bill, which a committee staff member identified as the "transparency and prior authorization act," would require utilization review entities to accept electronic prior authorization requests, set response timelines for urgent and emergency services, prohibit retrospective denials except for fraud, require peer‑to‑peer review options, and direct utilization review entities to submit annual prior authorization statistics to the Commissioner of Insurance for publication in the Kansas Register.
Supporters led by the Kansas Medical Society and clinicians said the current prior authorization system delays care and puts non‑specialist reviewers between patients and treating physicians. "It's simply gone too far," Rochelle Colombo, executive director of the Kansas Medical Society, told the committee. She said the society supports SB 330 as a step toward reducing harmful delays.
Pediatric gastroenterologist Rachel Chevalier of Children's Mercy Hospital described treating more than 700 patients with inflammatory bowel disease who face repeated annual prior authorizations. Chevalier said reviews sometimes take weeks and require explaining specialized pediatric care to reviewers who "are almost never a specialist in what you're working in." She asked, "Who am I proving necessity to?" and urged clearer peer‑to‑peer review standards for specialty care.
Physician Doug Grunbacher, representing the Kansas Academy of Family Physicians, cited national survey data and described administrative burdens at his clinic, including staff time devoted daily to paperwork and appeals. He recounted a case in which a required bone‑density test — paid out of pocket — delayed approval of a medication that ultimately prevented an invasive surgery for a family member.
Several patients gave personal accounts of clinical harm from delays. Angie Johnson, a chief nursing officer who described a three‑month delay before spinal surgery after insurers recommended non‑operative care, said the wait cost her work time and mobility and argued for standardized online portals and guaranteed turnaround times. "I really thought I was never going to be able to be a mom that could take care of my kids," she said of the period while awaiting surgery.
Carrie Padding, executive director of the Kansas chapter of the American Academy of Pediatrics, spoke as a parent of a child with cystic fibrosis and said families often must "re‑justify" life‑sustaining therapies each year. She cited device costs and months‑long waits for approval, and said the human cost of delays and denials "cannot be overstated." Patient Bryce Zogelmann described repeated denials and opaque communication while seeking approval for Rituxan for a rare kidney disorder.
Insurers and employer groups urged caution. Sarah Furdig of Blue Cross and Blue Shield of Kansas said the company agrees improvements are possible but warned the bill could conflict with existing Kansas law (she cited chapter 40 of the insurance code) and contains undefined terms — for example, provisions around "urgent" and "emergency" services that she said render parts of the bill "not implementable." Furdig also flagged the cost of mandated integrations with providers' electronic health records.
Andrew Weems of Kansas Employers for Affordable Healthcare said employers and payers rely on prior authorization to control costs and guard against fraud and urged negotiation among stakeholders rather than a prescriptive statutory approach.
Senators pressed witnesses about standards and specialty review. Senator Hill asked whether industry standards exist; Chevalier said guidelines cover common situations but many pediatric and rare cases lack comprehensive guidance, leaving specialists to rely on collegial expertise.
The committee did not vote on SB 330 on Wednesday and closed the public hearing, saying it would return to work on the bill. The chair also announced the committee would begin working on Senate Bill 360, a separate PBM reform measure, and indicated additional amendment work would continue the next day.
The bill text says any approved act would take effect upon publication in the Kansas Register. Committee members received nine written letters from proponents and several in‑person witnesses supporting the measure; insurers and employer groups offered written and oral opposition. The committee is expected to continue consideration at its next meeting.
