California’s comprehensive package of four bills designed to streamline the prior authorization process has successfully cleared a significant legislative hurdle, bringing potential relief to physicians and patients closer to reality.
Legislative Package Gains Momentum
The California Medical Association (CMA) announced on April 28 that the “Prioritizing Patients, Empowering Physicians” package has successfully passed out of both Senate and Assembly health committees. This legislative package, unveiled on April 10, represents a coordinated effort between the CMA, state legislators, and numerous physicians to address longstanding frustrations with the prior authorization process.
Understanding the Four-Bill Package
The reform package consists of four complementary bills, each targeting a specific aspect of the prior authorization process that has created barriers to timely patient care.
Eliminating Unnecessary Requirements
SB 306 introduces an efficiency-focused approach by requiring health plans to remove prior authorization requirements for any medical service that they approve more than 90% of the time. This common-sense measure aims to eliminate bureaucratic hurdles for treatments that are routinely approved, allowing physicians to deliver care without unnecessary delays.
Ensuring Qualified Medical Review
AB 510 addresses a critical concern regarding the expertise of those reviewing prior authorization requests. The bill mandates that appeals of prior authorization denials must be performed by a provider of the same or similar specialty as the requesting physician. This ensures that medical decisions are evaluated by professionals with relevant clinical expertise.
Accelerating Response Timelines
AB 512 significantly reduces the waiting period for prior authorization decisions. Under this bill, health plans would be required to respond to urgent requests within 24 hours and non-urgent requests within 48 hours. This represents a substantial improvement from current standards, which allow plans 72 hours for urgent requests and five days for non-urgent requests according to the CMA.
Extending Authorization Validity
AB 539 tackles the frustrating need for frequent reauthorizations by extending the validity of an approved prior authorization to one year. This represents a significant improvement from the current industry standard of 60 to 90 days, reducing administrative burden and improving continuity of care.
Next Steps in the Legislative Process
Following their successful passage through the health committees, these four bills will next be heard in the appropriations committees in their respective houses of origin. This represents another crucial step in the legislative journey toward implementation.
Potential Impact on California Healthcare
If passed into law, these reforms would significantly reshape how prior authorization functions in California, potentially creating a model for other states to follow. The package addresses many of the pain points consistently identified by healthcare providers, including unnecessary administrative burden, delays in patient care, and inconsistent decision-making.
By streamlining the process, these reforms aim to benefit all stakeholders in the healthcare system. Patients would experience fewer delays in receiving approved treatments, physicians could dedicate more time to patient care rather than paperwork, and even insurers could potentially reduce administrative costs associated with processing unnecessary authorizations.
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