For decades, both health professionals and patients alike have suffered from the consequences of prior authorization requirements. Important treatments and procedures are often put on pause for the sake of the finances or administrative inefficiencies of insurance companies. These treatment delays could even cause treatment abandonment after long periods of time. Michigan legislators sought to resolve this issue by approving a law that tightens the standards of authorization for insurance providers and accelerates the approval process, saving time, money, and even lives.
On March 23, 2022, the Michigan House of Representatives passed Senate Bill 247 by a vote of 103-2. The bill states that starting June 2023, health insurers must act on urgent prior authorization requests within 72 hours and non-urgent prior authorization requests within nine days, which will be narrowed to seven days by 2024. If the insurer fails to act within this nine- or seven-day period, the non-urgent prior authorization will be considered automatically granted. The decision on these prior authorization requirements must also now be based on peer-reviewed clinical review criteria.
In addition to these time and material restrictions, the law also requires insurers to implement an electronic process for prior authorization requests, making them more efficient. If any changes or additions arise on the existing requirements for health care providers, insurers must give notice.