SB441: Oklahoma Patients Protected Under New Prior Authorization Law

New rules ensure approved authorizations remain valid longer

This article was written with the assistance of ai software*

Photo byAuthor using Canva

What does SB441 want to accomplish?

SB441, called the "Ensuring Transparency in Prior Authorization Act," sets new rules for how insurance companies handle requests for medical treatments and medications.

Here's what it does:

➡️Easy Access: Insurance companies must put their rules for prior authorization (approval needed before certain treatments) on their websites, notify doctors about any changes, and share data on how often they approve or deny requests.

➡️Doctor Discussions: Before rejecting a treatment request, the insurance company must let doctors talk about why the treatment is needed. Only experienced doctors can make these decisions.

➡️Timely Decisions: Insurance companies must make decisions about treatment requests quickly—within 48 hours for regular cases and 24 hours for urgent ones. They can't ask for prior authorization for emergency care or medications for opioid addiction.

➡️Honoring Approvals: Once a treatment is approved, it can’t be taken back if the patient gets the care within 45 business days. The approval will still be valid even if the patient switches insurance plans.

➡️Electronic Requests: Starting January 1, 2025, insurance plans that cover medicines must accept and respond to authorization requests electronically using a specific secure system.

➡️Automatic Approval: If insurance companies don’t follow these rules, requests for treatment will automatically be approved.

Overall, this bill aims to make the process of getting approvals for medical treatments clearer, quicker, and fairer.

Who will benefit from this law?

✔️Patients: They will experience quicker approval times for needed treatments and medications, especially for urgent or emergency care. They won’t have to worry about their approvals being canceled if they switch insurance plans or providers.

✔️Doctors: They will have clearer and more transparent information about approval requirements and will be able to discuss the necessity of treatments directly with insurance companies before a decision is made.

✔️Healthcare Providers: They will benefit from more predictable and timely responses to authorization requests, which can improve their workflow and patient care.

✔️Insurance Companies: They can streamline their processes and reduce backlogs by adopting electronic systems for requests, which can lead to fewer automatic approvals due to non-compliance.

✔️Pharmacy Benefit Managers: They will be required to use secure electronic systems for processing requests, improving efficiency and reducing errors in handling prior authorizations.

What are some concerns people might have about this law?

⚠️Increased Administrative Burden: Healthcare providers and insurance companies might face additional administrative tasks to comply with new requirements, such as updating websites and handling more paperwork.

⚠️Implementation Costs: Health plans and utilization review entities may incur significant costs to update systems, train staff, and implement new processes, particularly the requirement to use electronic transmission systems.

⚠️Potential for Delays: While the law aims to speed up approvals, the transition to new systems and procedures could initially cause delays in processing prior authorizations.

⚠️Complexity for Providers: The new rules could make the prior authorization process more complex, particularly for smaller practices that may struggle with the added requirements and electronic systems.

⚠️Compliance Challenges: Utilization review entities might struggle to meet the new standards, leading to potential disputes over what constitutes compliance and further complications in handling authorization requests.

⚠️Impact on Insurance Plans: Insurers may face challenges in adjusting their processes to meet the new transparency and timing requirements, which could lead to inefficiencies or disruptions in service.

⚠️Limited Impact on Emergency Care: While the law addresses many areas of prior authorization, it does not fully address how emergency care and urgent needs will be handled, potentially leaving gaps in coverage for urgent situations.

⚠️Potential for Abuse: There may be concerns about how the new rules are enforced and whether they might be exploited by some parties, leading to unintended consequences or misuse of the authorization process.

This bill is making its way through the legislative process. If signed into law, it becomes effective November 1, 2024.

➡️Is this something that you think Oklahomans need? How will it benefit the county you live in?

*********************************************
Hi, I'm Judy! I love talking about the area I live in and what affects us. Follow me if you'd like more stories like this.