Momentum continues on state prior authorization bills
In 2024, nearly a dozen state prior authorization (PA) reform bills have been passed by state legislatures, and more are still being considered and/or waiting for governors’ signatures. Broadly, state bills are aiming to decrease the growing volume of PA requirements, reduce delays in patient care associated with PA, improve the transparency of PA rules and increase reporting of PA data.
For example, last week, Vermont Governor Phill Scott signed a bill championed by the Vermont Medical Society that limits PA requirements on primary care physicians and helps ensure that patients with chronic conditions will not have to continuously seek repeat PAs. The new law will also require that urgent PA requests are responded to within 24 hours. Additionally, and uniquely, the law requires health plans and physicians and other health care providers to report to the legislature in coming years on the impact of the law.
Similarly, Minnesota just enacted legislation supported by the Minnesota Medical Association that will prevent prior authorization on services including some cancer care, outpatient mental health care and preventive care. The law also prevents denials based solely on a lack of PA and prohibits most repeat PAs for patients with chronic conditions. Additionally, under the new law, PA data, including rates of authorizations and denials, will have to be submitted by the health plans to state regulators.
Earlier this year, the Wyoming Medical Society helped push broad legislation across the finish line that establishes an exemption, or gold carding, program for physicians, reduces plans’ response times, extends the duration of approvals and provides a grace period where insurers must honor PAs for patients switching plans. The new law, which resulted from months of negotiations between stakeholders, also prevents retroactive denials after an approval and targets harmful step therapy requirements.
Additional PA reform laws have also been enacted in other states including Mississippi, Maine, Maryland, Oklahoma and Virginia in 2024. These follow enactment of laws in the District of Columbia and New Jersey in January after years of work on the part of physicians and other stakeholders.
PA reform remains a top priority for the AMA as it continues to threaten the health of patients, frustrate physicians and waste valuable health care resources. The AMA offers state advocates numerous resources including model legislation (PDF), data (PDF) and grassroots opportunities.
Minnesota enacts important credentialing and wellness protections
Minnesota hospitals, health systems and other entities will no longer be allowed to require physicians and other health care professionals to disclose information about medical conditions that have no impact on the ability to provide safe, competent care. Senator Kelly Morrison, MD, and the Minnesota Medical Association (MMA) helped champion the bill into law. The AMA strongly supported the bill (PDF).
The law specifically prohibits credentialing applications from requiring disclosure of:
- Past health conditions.
- Current health conditions, if they are being treated so that the condition does not affect the provider's ability to practice medicine.
- Any health conditions which would not affect the provider's ability to practice medicine in a competent, safe and ethical manner.
“Physicians and medical students who need mental health care are not always getting it because they are worried they’ll need to report their treatment to health plans and hospitals to be employed, even though it has no impact on their ability to practice,” said Dr. Morrison. “We need to continue to destigmatize mental health care so physicians can get the care they need. This was a priority to get passed this year. It will help doctors take better care of themselves so they can care for their patients.”
In addition to the credentialing reforms, the new law creates significant confidentiality protections for a “physician wellness program.” The law’s confidentiality provision states that: “Any record of a person's participation in a physician wellness program is confidential and not subject to discovery, subpoena, or a reporting requirement to the applicable board, unless the person voluntarily provides for written release of the information, or the disclosure is required to meet the licensee’s obligation to report according to Minnesota law.”
