Prior Authorization, Other Key Legislation the Focus of Lame Duck

December 18, 2020—This week of the lame-duck session brought much more activity than in previous weeks. The House met all three days, with a busy session agenda each day, while the Senate held votes on Wednesday and Thursday. Both have added additional sessions. After missing all session days last week due to COVID-19 concerns, the House added a session day scheduled for Monday, Dec. 21 and the Senate is meeting today, Dec. 18. MAFP has been monitoring many pieces of legislation for their potential to move to passage.

Naturopaths

House Bills 5302 and 5303 would set education requirements and scope of practice for naturopaths, allowing them to call themselves physicians. These bills continue to remain before the House Regulatory Reform Committee with no action or testimony taken. MAFP continues to stand in opposition to these bills, as they pose a risk to the public due to potential negative health outcomes. No action is expected to be taken on the legislation.

Emotional Support Animals

House Bills 4910 and 4911, which set housing regulations for certification of emotional support animals, passed the Senate on Thursday. The bills will require a concurrence vote to the Senate changes when they are reported back to the House. MAFP continues to have several concerns regarding the legislation, but many changes recommended by MAFP have been adopted. We remain hopeful for a veto by Gov. Whitmer, as concerns have been raised that these bills could be in violation of federal regulations.

Canadian Healthcare Professionals

Legislation that would allow for Canadian healthcare professionals to be licensed, registered, or certified in Michigan passed the legislature and awaits the Governor’s signature for final adoption. Senate Bill 1021 would allow for a Canadian licensed healthcare professional to be given a Michigan license under certain conditions. Anyone wishing to obtain this license would have to meet certain education and training standards that align with the standards of licensure in Michigan.

Healthcare Immunity Act

A new healthcare immunity act, in Senate Bill 1185, would repeal and replace the previous liability immunity bill passed earlier this year. Under the new act healthcare professionals and facilities would continue to not be liable for injury or harm in response to the COVID-19 pandemic. The act differs in the dates allowed for immunity, which would include March 29-July 13, 2020 and October 30, 2020-February 13, 2021. Also added into immunity under the new act would include psychiatric units, psychiatric hospitals, and nursing home care and recovery centers.

COVID-19 Response Supplemental Funding

Gov. Whitmer has called for the Legislature to pass an addition $100 million in business relief and another $300 million in General Funds to assist in the state's COVID-19 response. The Legislature is eyeing less than $300 million for a response package. In the late hours on Dec. 18, the House passed and sent back to the Senate Senate Bill 604, which extends unemployment benefits from 20-26 weeks and extends them through March 31, 2021. Final details are still unknown as the Senate is working on this issue on Dec. 18. Funding is planned to be used toward testing and vaccine distribution and helping with the shortage of nurses and other healthcare professionals in hospitals and other healthcare facilities. The expectation is that the House will concur with Senate changes on Monday, Dec. 21, and then send the spending bill to Gov. Whitmer.

Prior Authorization

Senate Bill 612, which calls for reforming the prior authorization and step therapy processes by introducing new transparency, fairness, and clinical validity requirements, was passed by the Senate following the adoption of substituted language. MAFP and the Health Can't Wait coalition, of which the Academy is a member, have major concerns with the changes in the substitute, as many of the important provisions included the bill have been removed. With these and other changes, the bill appears be more favorable to the insurance companies and veers from its original intent. Some of these changes include:

  • Removes step therapy; however, this is not unexpected and a stand-alone step therapy bill will be introduced in 2021
  • Separates prior authorization for medications from prior authorization for other services and treatments
  • Removes language requiring prior authorization criteria at point of care
  • Replaces language prohibiting the developers of clinical review criteria from having a “financial stake” in outcomes to not receiving “direct payments” for outcomes.
  • Excludes the requirement to seek input from physicians when prior authorization for medications are established or changed; it instead requires input only from pharmacists
  • No longer requires physician review when denying a prior authorization request
  • Requires adverse decisions of prior authorization for medications be made by a pharmacist, which may be an inadvertent scope expansion as the pharmacist could now direct physicians on what they can and cannot prescribe
  • Allows non-physician health professionals review appeals
  • Removes the requirement that a physician in the same specialty as the physician making the prior authorization request review appeals of adverse denials, and only provides that a physician must review denials the non-physician health professional wants to affirm
  • Changes language that allows for a prior authorization request to restart the response timeline each time an adjustment or addition of information is requested
  • Removes all language requiring insurers to publicly post data on prior authorization approvals and denials

Due to these concerning changes, MAFP and the Health Can't Wait coalition are requesting the House take no action on Senate Bill 612 in the remaining session day it has scheduled. The new goal is to work with the opposition and sponsor to bring back the vital aspects of the legislation and begin moving again in the new legislative term that starts in January.