GOP lawmakers are seeking to make changes to the prior authorization process in Wisconsin, in which health care providers have to get an OK from insurers for certain medical services.
Sen. Patrick Testin of Stevens Point and Rep. Nancy VanderMeer of Tomah recently sent a cosponsorship memo on the bill to other lawmakers, arguing this process has “increasingly become a significant barrier” to patients receiving timely and effective care.
They say the rise of third-party reviewers in the health care field — such as utilization review organizations or utilization management organizations — has complicated the prior authorization process.
These entities aim to ensure the requested service or procedure is appropriate and delivered in the correct setting, for the purposes of cost control, care coordination and improved internal communication, according to a report published online in the National Institutes of Health’s National Library of Medicine.
But Testin and VanderMeer argue this process has “led to significant administrative burdens for both providers and patients, ultimately resulting in delays in care and adverse patient outcomes.”
To support that notion, they reference a survey of physical therapy providers from the state chapter of the American Physical Therapy Association. The survey found 90 percent of physical therapists reported the prior authorization process has led to gaps in patient care, while 78 percent said it has delayed patient progress and 52 percent said it has led to patients “abandoning” care, the memo shows.
The Legislative Reference Bureau notes the bill would make changes to the prior authorization process for physical therapy, occupational therapy, speech therapy, chiropractic services, and other health care services by certain health plans.
Under the legislation, any decision on reauthorizing coverage for a service that was previously approved would need to be made within 48 hours, or prior authorization is assumed, according to the memo. Plus, requiring prior authorization for the first 12 sessions of physical, occupational or speech therapy, or chiropractic visits, would be prohibited.
The bill would also disallow requiring prior authorization in chronic pain cases for the first 90 days, require compensation for the time spent entering information required for third-party authorization, and bar the third-party groups from using claims data as “evidence of outcomes” for developing approval policies, among other changes.
It’s supported by the Wisconsin Speech-Language Pathology and Audiology Association, the Wisconsin Occupational Therapy Association, the Wisconsin Chiropractic Association, the Chiropractic Society of Wisconsin, and the American Physical Therapy Association-Wisconsin, the memo shows.
The cosponsorship deadline is 5 p.m. tomorrow.
See the memo:
See the NLM report here: https://www.ncbi.nlm.nih.gov/books/NBK560806/
–By Alex Moe
