Enacts provisions relating to prior authorization of health care services
The impact of SB230 is expected to streamline the process for health care providers when seeking approvals for services, thereby facilitating quicker patient care decisions. By mandating that authorization requirements only apply when a provider's approval rate is low, it incentivizes health carriers to improve their approval rates. This legislation could also encourage more transparency in the decision-making process, as health carriers must notify providers of their approval statistics, which may lead to improved communication between providers and insurers.
Senate Bill 230 aims to amend chapter 376 of the Revised Statutes of Missouri with new provisions specifically relating to prior authorizations for health care services. The bill introduces several sections that define the circumstances under which a health carrier or utilization review entity can require prior authorization from health care providers. Notably, under this bill, a provider is only required to obtain prior authorization if less than 90% of their prior authorization requests were approved in the most recent evaluation period. This presents a significant shift in the standard, potentially reducing the burden on healthcare providers seeking prior authorizations.
While SB230 has the potential to enhance provider efficiency and patient care, there are concerns about its implementation. Critics argue that there may be loopholes that health carriers could exploit, potentially leading to inconsistencies in approval rates. Additionally, the bill does not apply to MO HealthNet, which raises questions about the equity of its provisions across different levels of healthcare coverage. Stakeholders in the healthcare system, including patient advocacy groups and health providers, are likely to have varied opinions on the necessity and efficacy of such regulations.
The bill also establishes an appeals process for providers who are denied prior authorizations and requires health carriers to maintain an online portal for access to prior authorization decisions. This increases accessibility for health care providers, but it is also crucial to monitor how effectively these new regulations are enforced and whether they lead to the intended outcomes without causing further complications in the system.