Health insurers; authorize exemption from prior authorization requirements of for health care providers if certain criteria are met.
The bill modifies existing statutes under the Mississippi Code, creating new sections to codify this exemption process. Health insurers will be required to evaluate whether physicians qualify for the exemption regularly. If a provider is found to continue meeting the exemption criteria, they can proceed to provide services without going through the prior authorization process, which has historically delayed patient care. The bill also stipulates that insurers cannot deny or reduce payment for services covered under this exemption unless there's clear evidence of malpractice or misrepresentation.
House Bill 780 introduces significant changes to the prior authorization requirements for health care services provided by physicians and other providers in Mississippi. The bill aims to reduce the administrative burdens on health care providers by allowing exemptions from prior authorization processes if a health insurer has a strong approval rate—specifically, if at least 90 percent of prior authorization requests for certain services are approved over the last six months. This change seeks to streamline access to timely and necessary health care, thereby benefiting both providers and patients.
Opposition to the bill stems from concerns about the potential for undermining medical oversight in the authorization processes. Critics argue that, while the bill aims to simplify access to care, it could lead to situations where medical necessity is not adequately evaluated, possibly impacting patient safety and service quality. There will also be a mechanism for independent reviews of expunged exemptions, ensuring accountability and oversight in the exemption reassessments, thereby addressing some concerns raised by the bill's detractors.