Health insurance; to regulate and modernize the prior authorization process
Impact
The legislation is designed to streamline the prior authorization process by establishing clear guidelines for health insurers. By requiring that all adverse determinations on requests for prior authorization be made by appropriately licensed healthcare professionals, the bill seeks to improve the quality of care provided to patients by ensuring that decision-makers are suitably qualified. Additionally, it sets a precedent for the automatic approval of claims if these determinations are not completed in a timely manner, potentially reducing delays in patient care.
Summary
SB294, titled the Alabama Utilization Review Modernization Act, aims to amend and clarify the requirements for health insurance providers regarding the prior authorization process. The bill mandates that health insurers cannot deny payment for healthcare services without following stipulated timeframes for decision-making, which encourages more timely access to necessary medical treatments. Beginning January 1, 2026, insurers will have to grant exemption from prior authorization for healthcare professionals who frequently demonstrate that their claims meet medical necessity criteria.
Contention
Despite its potential benefits, the bill has faced criticism regarding its impact on the ability of health insurers to manage costs and ensure appropriate use of medical services. Some opponents argue that while the bill aims to reduce bureaucracy, it could inadvertently increase overall healthcare costs by making it easier for unnecessary treatments to receive approval. The balance between ensuring patient access to care and maintaining cost-effectiveness for insurers has emerged as a significant point of contention during discussions around the bill.
Office of Occupational and Professional Licensing, created within the Department of Labor; oversight provided to professional or occupational licensing boards.
Sinkhole loss insurance coverage, homeowners insurance policies, require to cover catastrophic ground cover collapse and optional coverage for sinkhole damage.
Permits EMT, paramedic, or investigator for county medical examiner's office to make determination and pronouncement of death under certain circumstances.