By PAULA TRACY, InDepthNH.org
CONCORD – Pursuant to a brand new regulation designed to streamline the method of getting permission for prior authorization of some well being procedures, the state Insurance coverage Division issued a bulletin Friday detailing the method for well being insurers and associated entities.
The brand new regulation shortens the time allowed for well being carriers to make selections relating to prior authorizations, permits suppliers broader entry to peer-to-peer overview, and requires the Insurance coverage Division to gather and disclose sure metrics referring to prior authorizations.
“It’s actually a terrific reform initiative,” stated Insurance coverage Division Commissioner DJ Bettencourt in a telephone interview.
Bettencourt careworn that the method to succeed in a compromise included lawmakers, insurance coverage carriers, the New Hampshire Hospital Affiliation, suppliers, his division and sufferers.
“In the end there have been incentives for all events to insure the method works for sufferers,” Bettencourt stated.
He stated one of many provisions contains deadlines for selections to be made about prior authorization.
If they aren’t met, the prior authorization is assumed to be routinely accredited, Bettencourt stated.
The division’s letter to insurers and different entities dated Jan. 2 stated the bulletin is efficient instantly.
The bulletin outlines important requirements and expectations for insurers, healthcare suppliers, and others engaged within the prior authorization course of.
“These updates are designed to deal with frequent challenges in acquiring well timed authorizations, decreasing administrative delays, and fostering clear communication amongst all events concerned in affected person care,” in response to the division.
Sponsored by state Sen. Denise Ricciardi, R-Bedford, the Home of Representatives and state Senate each handed Senate Invoice 561 final spring establishing standards for prior authorization necessities by insurers of managed care advantages which was signed into regulation by Gov. Chris Sununu in June.
A replica of the invoice is right here https://legiscan.com/NH/textual content/SB561/2024
“These updates reaffirm our dedication to making sure that prior authorization processes don’t function a barrier to important healthcare companies for Granite Staters,” Bettencourt stated. “By refining these protocols, we purpose to keep up the meant objective of prior authorization: to forestall premium will increase whereas supporting high-quality, environment friendly, and patient-centered healthcare supply in our state.”
Key provisions embody:
– Standardized time frames for decision-making to forestall pointless delays in care supply.
– Improved documentation necessities to reinforce the accuracy and completeness of authorization requests.
– Enhanced mechanisms for appeals and grievances to deal with denials of prior authorization requests.
The three-page bulletin is offered at https://mm.nh.gov/information/uploads/nhid/paperwork/ins-25-001-ab-prior-auth.pdf.
It notes the Insurance coverage Division is within the means of rewriting administrative guidelines pertaining to utilization overview to deal with these statutory adjustments.
Reporter Nancy West contributed to this report.
