Utilization review; prior authorization; requirements
The legislation introduces significant changes to the way prior authorizations are managed within Arizona healthcare. It aims to provide stability for patients by ensuring that previously approved services continue to be honored despite changes in insurance coverage. The bill also enhances transparency around prior authorization processes, requiring insurers to publish their requirements and provide a notification period before any changes are implemented. This could lead to a modest reduction in administrative burdens on healthcare providers and improve the accessibility of care for patients.
SB1512 aims to amend the Arizona Revised Statutes to provide new provisions regarding utilization reviews and prior authorization requirements for health care insurers, pharmacy benefit managers, and utilization review agents. The core idea is to ensure that if a member changes their health insurance, any prior authorization granted for a service must be honored by the new insurer for the first ninety days, unless specifically excluded by the new plan. This mandates a smoother transition for patients who switch insurance plans, ensuring they don’t face immediate roadblocks in obtaining previously approved health services.
While the bill strives to protect patient access to medically necessary services, there may be concerns regarding its implementation and the potential for increased costs for insurers. Critics could argue that mandating a continuation of prior authorizations without reassessment could lead to unnecessary expenditures as insurers may end up covering services that may no longer be the most appropriate under the new insurance policy. Moreover, the practical aspects of enforcing these requirements across various insurers could pose challenges, particularly concerning the notification processes and the enforcement of the stipulated guidelines.