Requires insurers and health plans to grant automatic preauthorization approvals to eligible health care professionals in certain circumstance

◆ The sponsor's argument

Why James Skoufis says this is needed

Many studies have highlighted the increasing challenges health care providers face in delivering timely care, including the burden of prior authorization (PA) requirements. PA is a utilization management tool that requires physicians to obtain approval from a health plan before proceeding with specific treatments, tests, or services. While intended to control costs and ensure appropriate care, PA is often applied more broadly than necessary. According to a December 2020 survey by the Amer- ican Medical Association (AMA), 91% of physicians reported that PA caus- es significant delays in patient care. Additionally, 87% indicated that PA disrupts continuity of care, and 83% noted an increase in required PAs over the past five years. This overuse leads to unnecessary administrative burdens, diverting valuable time from patient care and contributing to widespread provider burnout. In response, states such as Texas, California, Louisiana, and Michigan have introduced or passed "Gold Card" laws. These laws exempt providers from PA requirements for specific services if they have a history of frequent approvals, typically 90% or.more, over a defined period. This legislation mirrors that approach, with automatic preauthorization approval granted for six months and then reevaluated annually. It has been likened to the TSA PreCheck program, which offers expedited screen- ing for trusted travelers. However, early implementation in Texas has encountered significant issues. Only 3% of providers have qualified for gold cards due to stringent eligibility thresholds and inconsistent definitions of services across insurers. Furthermore, a KFF survey found that a quarter of adults dealing with insurance issues related to PA reported a decline in their health, while a third experienced increased out-of-pocket costs. These findings underscore the urgent need for more balanced, effective reform.

This is the sponsor's own case for the bill, quoted from their memorandum. It is not Agora's description of what the bill does.