Revises provisions relating to health insurance. (BDR 57-238)
The legislation aims to enhance patient access to necessary health care services by streamlining the prior authorization process. It potentially reduces delays experienced by patients and providers when seeking approvals for medical treatments. Furthermore, insurers are required to compile and publish annual reports that detail their prior authorization activities, thereby increasing transparency in the insurance approval process.
Assembly Bill 295 seeks to amend provisions related to health insurance, specifically focusing on the prior authorization requirements imposed by insurers. The bill establishes strict timelines for insurers to approve or deny requests for authorization, mandating that decisions be made within five days for non-urgent care and within 48 hours for urgent care. Additionally, if an insurer employs an artificial intelligence system to process these requests, it must disclose this usage to insured individuals, limiting the AI's role in making adverse determinations without a qualified health professional's review.
The sentiment surrounding AB 295 is mixed. Proponents argue that the bill represents a significant step towards protecting patients from unnecessary bureaucratic hurdles, thereby promoting better health outcomes. They believe that by ensuring quicker access to treatments and creating a framework for responsibility in the use of AI, this legislation aligns with patient-centered care objectives. Conversely, opponents raise concerns about the potential for increased administrative burdens on insurers, which could lead to higher costs passed down to consumers in the form of premiums.
Key points of contention include concerns about the feasibility of the timelines set within the bill and the implications of disclosing the use of AI in decision-making processes. Critics argue that hastening approval processes may compromise thorough evaluations of medical necessity, while advocates emphasize the importance of timely access to services. Furthermore, the requirement for annual reporting may be viewed as burdensome for some insurers who feel it could lead to excessive scrutiny.