Missouri Senate Bill SB947

Missouri 2022 Regular Session

• Introduced: 1/5/22
• Refer: 2/16/22

Caption

Enacts provisions relating to prior authorization of health care services

Impact

The proposed changes will specifically impact the operations of health carriers by mandating that if a provider has been approved for a significant percentage (90%) of their prior authorization requests over a recent six-month period, they will be exempt from needing further authorizations for similar services. This is designed to incentivize health carriers to fairly assess and approve requests, ultimately improving the efficiency of healthcare delivery and reducing delays in patient treatment.

Summary

Senate Bill 947 aims to amend chapter 376 of Missouri's Revised Statutes by introducing provisions related to the prior authorization of healthcare services. This bill seeks to establish clear regulations and criteria for health carriers and utilization review entities regarding the necessity of prior authorizations. A major focus of the bill is to reduce the administrative burdens faced by healthcare providers and ensure that prior authorization issues do not hinder patient access to necessary health services. Under the new law, providers who meet specific approval criteria will be exempt from prior authorization requirements, streamlining their interactions with insurance companies.

Contention

However, the bill has sparked debate among stakeholders, particularly around concerns about medical necessity and potential misuse of exemptions. Some advocates question whether the 90% approval threshold adequately ensures that healthcare services provided to patients meet necessary standards. Critics argue that while the intent is to ease burdens on providers, there must still be rigorous oversight to prevent fraudulent claims and ensure patient safety. Moreover, it has been suggested that this could lead to a reduction in quality control over healthcare services if not appropriately managed.