Indiana House Bill HB1271

Indiana 2022 Regular Session

• Introduced: 1/10/22
• Refer: 1/10/22

Caption

Health care prior authorization.

Impact

The broader implications of HB 1271 could lead to reduced delays in the delivery of care, as the legislation facilitates direct dialogue regarding adverse decisions affecting patient treatment. In addition, the bill introduces the concept of exemption periods, where if a health care provider achieves a 90% approval rate for prior authorization requests during an evaluation period, they will not need to request prior authorization for six months following this period. This has the potential to reduce the administrative burden on providers and may improve patient access to timely care.

Summary

House Bill 1271 is a significant piece of legislation aimed at reforming the process of health care prior authorization in Indiana. The bill mandates that health plans must provide health care providers an opportunity for a peer-to-peer discussion when an adverse determination is made regarding prior authorization requests. Furthermore, it establishes a timeline for such discussions, requiring health plans to offer this within seven business days of a request. By focusing on enhancing communication between health care providers and health plans, the bill ultimately hopes to streamline the authorization process for necessary health care services.

Conclusion

Overall, HB 1271 represents a legislative effort to make healthcare access more equitable and efficient for patients in Indiana, while also placing safeguards against possible fraudulent practices. The success of the bill will largely depend on how effectively the provisions are implemented and the actions taken by health plans in response to the new requirements.

Contention

However, there are notable points of contention regarding the efficacy of the metrics established for maintaining exemptions and the potential for misuse of the independent review process. Critics might argue that the requirement to maintain a high approval rate could dissuade health plans from denying unnecessary services, ultimately impacting cost management. Moreover, the conditions under which exemptions can be rescinded include serious allegations of fraud or incompetence, which raises concerns regarding how health plans might wield this power, potentially leading to unjustified rescissions.