LANSING, Mich. — Sen. Curt VanderWall’s legislation to improve the administration of effective, patient-centered care in the state was signed into law Thursday by Gov. Gretchen Whitmer.
Senate Bill 247, now Public Act 60 of 2022, improves the prior authorization process health insurance companies use to determine if an insured person is eligible to have certain health care services, procedures or prescription drugs covered.
“Today’s action by Gov. Whitmer to sign this overwhelmingly bipartisan legislation will directly help patients across Michigan,” said VanderWall, R-Ludington. “This new law reforms the prior authorization process, which has created barriers and inefficiencies with access and quality of care in the health care system. It will promote transparency in practices used by insurers, allowing enrollees and health care providers to be fully informed while making coverage and care decisions.”
SB 247 requires that beginning June 1, 2023, insurers and health care providers and professionals must perform the prior authorization process solely through the use of a standard electronic transaction.
The legislation also will ensure that insurance companies are creating prior authorization requirements based on relevant and up-to-date evidence-based clinical guidelines — and not solely on cost containment — and improve an enrollee’s ability to receive prompt access to necessary care by reducing the review timeframes permitted for insurance companies to make determinations for standard (non-urgent) and urgent prior authorization requests.
“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. “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.”