Gov. Gretchen Whitmer has signed legislation that reforms how physicians and hospitals seek prior authorization from health insurers for patient care.
The new law shortens the time for health insurers to respond to a prior authorization request from physicians and implements other changes.
In signing the legislation that passed by wide margins in both the state House and Senate, Whitmer “ushered in a new era where transparency, clinical validity and fairness to patients will all be factored into the prior authorization process, protecting Michigan patients from costly and dangerous delays in access to health care,” Michigan State Medical Society President Dr. Pino Colone said in a statement.
“Today is a wonderful day for Michigan patients who can now rest easy knowing insurance company prior authorization practices will no longer prove to be an impassable roadblock between them and the timely care and treatment they too often desperately need,” said Colone, an emergency medicine specialist at Henry Ford West Bloomfield Hospital. “Officially signing this bill into law is a tremendous, and much needed, win for countless Michigan patients and the providers who serve them.”
Reforming Michigan’s prior authorization process has been a key legislative priority in recent years for the Medical Society. The Medical Society, which represents more than 15,000 doctors across the state, argued that prior authorization has expanded from requirements on higher-cost procedures, tests and medications to now affecting routine medical services, leading to delays in care.
Under the new law, health insurers initially would have nine calendar days beginning Jan. 1, 2023 to grant or deny a prior authorization request for non-urgent care before it’s considered granted. That timeline will drop to seven calendar days after Dec. 31, 2023. Health insurers also would have to grant or deny urgent care requests within 72 hours of submission.
The timelines would begin once a physician has submitted all of the information that a health insurer needed to review a prior authorization request.
The law also would require physicians to submit prior authorization requests to insurers electronically in a standardized format that should speed up the process, and sets criteria for appeals and requires insurers to base decisions on peer-reviewed clinical standards.
State Sen. Curtis VanderWall, R-Ludington, who sponsored the legislation, said the “overwhelmingly bipartisan legislation will directly help patients across Michigan.”
“While the intent behind the prior authorization process is to promote safe, timely, and cost-effective care, the process itself has been widely viewed as inefficient and burdensome,” VanderWall said in a statement released by the governor’s office. “This can directly affect the treatment and care a patient receives and could pose significant risks to a patient’s health. This law will help improve the process and ultimately benefit patients.”