What's Happening?
The National Council of Insurance Legislators (NCOIL) is addressing the issue of prior authorization in healthcare with a proposed 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 all health insurance issuers and health benefit plans, excluding self-insured plans under ERISA and Workers’ Compensation. The act includes provisions for clinical review criteria based on nationally accepted standards and evidence-based sources.
Why It's Important?
The proposed model act by NCOIL is crucial as it seeks to streamline the prior authorization process, which has been a contentious issue in healthcare. By ensuring transparency and consistency, the act could improve patient access to necessary medical services and reduce administrative burdens on healthcare providers. This reform could lead to better healthcare outcomes and enhance the efficiency of healthcare delivery.
What's Next?
The model act will be presented at NCOIL's annual meeting, where further discussions and potential revisions may occur. Stakeholders, including healthcare providers and insurers, will likely engage in dialogue to refine the act and address any concerns. The implementation of the act could lead to changes in how prior authorizations are handled across the healthcare industry.
