NCOIL Model Act Targets Prior Authorization in Healthcare

What's Happening?

The National Council of Insurance Legislators (NCOIL) is addressing the issue of prior authorization in healthcare through its Prior Authorization Reform Model Act. The act aims to protect the healthcare professional-patient relationship from third-party interference and ensure transparency in the authorization process. It applies to health insurance issuers, health benefit plans, and private review agents, excluding self-insured plans under ERISA and Workers' Compensation. The act mandates clinical review criteria consistent with nationally accepted standards and requires insurers to post prior authorization information online, including reasons for denials and appeal instructions.

Why It's Important?

Prior authorization has been a contentious issue in healthcare, often criticized for delaying patient access to necessary treatments. NCOIL's model act seeks to streamline the process, ensuring that clinical decisions are based on evidence and recognized standards. By enhancing transparency and accountability, the act could improve patient care and reduce administrative burdens on healthcare providers. This initiative reflects broader efforts to reform healthcare practices and policies, potentially influencing how insurers and providers manage patient care and authorization processes.

What's Next?

NCOIL will present the model act at its annual meeting in November, where further discussions and potential revisions may occur. Stakeholders, including healthcare providers and insurers, are likely to engage in dialogue to refine the act's provisions. If adopted, the model act could serve as a template for state legislation, prompting changes in prior authorization practices nationwide. The healthcare industry may need to adapt to new standards and processes, potentially leading to improved patient outcomes and more efficient care delivery.