Prior Authorization Reforms in Federal and State Spotlight

April 15, 2021Due to concerns over delays to patient care, reforming the prior authorization process is picking up steam nationally and in Michigan.

At the federal level, American Academy of Family Physicians, American Medical Association, and 38 other organizations sent a letter to the Centers for Medicare and Medicaid Services’ acting administrator to express growing concern with expanding use of prior authorization requirements. The letter details recent CMS practices that are contrary to its historic use of prior authorization in very limited circumstances.

In Michigan, the Senate Health Policy and Human Services Committee heard testimony this week on Senate Bill 247—the recently re-introduced prior authorization reform bill that is similar to SB 612, which expired at the end of the 2020 legislative session.

As currently written, SB 247 calls for introducing many new transparency, clinical validity, and fairness requirements that the Health Can’t Wait Coalition, of which MAFP is a member, has been advocating for.

During the hearing, patient advocates joined physicians and other healthcare professionals explained how delays and lack of transparency in the current piror authorization process often results in negative health outcomes, while insurance company representatives testified in opposition to the bill. The Senate panel adopted a substitute bill with some amendments but not not move the bill out of committee.

As SB 247 continues to move through the state legislative process, the MAFP advocacy team, spearheaded by Director of Government Affairs Matt Black, continues to work to ensure the reforms are as robust as possible and protect patients’ access to care while not putting burdens on physicians.