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House of Representatives
Session of 2017 - 2018 Regular Session


Posted: March 21, 2017 11:56 AM
From: Representative Marguerite Quinn
To: All House members
Subject: Prior Authorization of Medical Services in Pennsylvania
Administrative waste in the health care delivery system is a significant problem, causing both lost time and added expense. Authorization from an insurance provider prior to a medical test or procedure is one example of an inefficient process that increases costs for providers, their patients and all policy holders. The lack of standardization of paperwork makes the prior authorization process difficult and time consuming. Additionally, the current prior authorization process can sometimes delay needed care for Pennsylvania residents. To reduce this delay in care, costs and frustration all around, the prior authorization process needs to be standardized and streamlined. Therefore, I will introduce legislation that focuses on the streamlining and standardization of the process for prior authorization of medical services in Pennsylvania.

My bill will improve transparency, accessibility and consistent application of prior authorization by including a standard definition. It will also significantly streamline the process by requiring insurers to make available an electronic communications network that permits prior authorization requests to be submitted electronically, and authorizations and adverse determinations to likewise be returned electronically.

Transparency and consistent application of prior authorization criteria and clinical expectations will be enhanced by requiring the disclosure of prior authorization requirements, restrictions and/or amendments to subscribers and physicians.

Improved patient care will result from requiring consistent response times and processes with respect to prior authorizations, adverse determinations, and appeal procedures, including external review.

Practice efficiency will be improved by establishing limitations on routine medical record requests by insurers, consistent with the privacy limits placed on physicians by HIPAA, and by excluding treatment utilizing Appropriate Use Criteria, where available, from the prior authorization process.

A key element of the bill will be the development of a standard prior authorization form that can be electronically submitted by all health care providers and accepted by all health insurers.

Please join me in co-sponsoring this important health care reform legislation.

Introduced as HB1293