Insurance; health care provider to respond to a private review agent or utility review entity's attempt to discuss the patient's care; detail the effort
Impact
The bill stipulates that each health insurer utilizing prior authorization must implement a program that selectively reduces prior authorization requirements based on healthcare providers' performance and adherence to evidence-based medicine. This is anticipated to lead to reduced administrative burdens and improve the efficiency of healthcare delivery, making it easier for providers to recommend and deliver necessary care without being hindered by excessive bureaucratic procedures. Additionally, the bill will establish criteria for participation by healthcare providers in these selective programs, requiring annual reporting to the state department.
Summary
House Bill 197 seeks to amend the Official Code of Georgia to enhance communication between healthcare providers and private review agents or utility review entities concerning a patient's care. This bill mandates that healthcare providers must be able to discuss treatment plans with clinical peers before any adverse determinations are made regarding medical necessity. Such discussions are aimed at ensuring that patient care decisions are made with adequate input from the treatment provider, which may improve healthcare outcomes and patient satisfaction.
Sentiment
The sentiment surrounding HB 197 appears supportive, particularly among healthcare professionals and advocates who favor reducing cumbersome prior authorization processes. Proponents argue that the bill will ultimately enhance the quality of patient care by allowing timely clinical discussions and reducing delays in treatment. However, some skepticism remains regarding the implementation of these changes and whether they will sufficiently address the issues currently faced by providers and patients alike.
Contention
Notable points of contention include the bill's potential implications for the authority of private review agents. Critics might raise concerns about how effectively these agents can be regulated to ensure that the interests of both healthcare providers and patients are balanced. There may also be worries about the extent to which insurers can apply selective reductions in prior authorization—whether these criteria will be equitable and transparent, and how they will impact care for diverse patient populations.
Insurance; discriminating against certain healthcare facilities and providers in connection with the administration of provider administered drugs; prohibit insurers
Public officers and employees; supplemental, illness-specific insurance for certain first responders with occupational post-traumatic stress disorder; require provision