Enacts provisions relating to prior authorization of health care services
One of the pivotal changes introduced by SB983 is the stipulation that prior authorization can only be required if a provider's approval rate for such requests falls below 90% over the most recent evaluation period. This provision can potentially reduce the instances where providers are unreasonably burdened by the necessity to seek prior approval for services that are routinely authorized. The bill further mandates that health carriers notify providers of such determinations in a timely manner, ensuring transparency and accountability in the authorization process.
Senate Bill 983 aims to amend Chapter 376 of Missouri state law regarding the prior authorization requirements for healthcare services. The bill sets forth specific conditions under which health carriers and utilization review entities may require healthcare providers to undergo prior authorization processes. In essence, it seeks to streamline the prior authorization requirements, attempting to mitigate the administrative burdens that healthcare providers often face when seeking approval for necessary services.
Notably, SB983 acknowledges concerns regarding the current system, where prior authorization requirements can lead to delays in patient care. However, the bill excludes Medicaid provisions, which has generated some debate about its comprehensiveness and whether it adequately addresses the needs of all healthcare providers across different programs. Thus, while it aims to improve the efficiency of prior authorization processes, stakeholders continue to discuss the implications of these changes, particularly concerning access to care for lower-income populations.