Preauthorization for health care takes Tuesday’s spotlight in Texas Senate Finance Committee


AUSTIN (Nexstar) — With less than two weeks left in the legislative session, Texas lawmakers spent Tuesday addressing health plans and preauthorization for health care coverage.

In the Texas Senate Finance Committee, lawmakers heard testimony on House Bill 3459, a proposal billed by supporters as a plan to remove barriers to healthcare.

“For many patients, the administrative implications of these mandated protocols translate to delays of much-needed care, poor clinical outcomes and at times may result in the patient failing to receive medically necessary care altogether,” said the bill’s Senate sponsor, State Sen. Dawn Buckingham, R-Lakeway.

Buckingham said the current process for prior authorization — or approval by an insurance company before a medical professional prescribes medication or performs a procedure — and utilization review — reviewing care and making sure it will be covered by insurance — has become inefficient, complex and burdensome and “ultimately results in denying many Texans essential health care services.”

The legislation would require physicians who review health plans as part of the prior authorization and utilization review process to be licensed in Texas and practice in a similar specialty as the doctor prescribing the medical care.

Under HB 3459, doctors who had 80% of their preauthorization requests approved by the insurer in the previous calendar year would no longer need preauthorization for the next year.

Prior authorization was initially implemented as a check on the health care system to prevent fraud, waste and abuse by doctors and patients.

Jamie Dudensing, RN, MPA, argued HB 3459 would remove a layer of accountability.

“It should have some accountability on the back end. You should have some accountability for fraud, waste, and abuse. You should have some accountability for that quality of care, and you should have some accountability for those metrics that have been developed by the medical community to follow,” said Dudensing, CEO of the Texas Association of Health Plans.

A breast medical oncologist testifying on behalf of the Texas Medical Association argued the bill would reduce delays in care.

“Patients and physicians would like to reduce the intrusive impact of prior authorizations on the patient-physician relationship, as obviously I make very specific decisions for the patients that I serve, and if I do that routinely, and systematically, appropriately, I shouldn’t be held to that same burden,” Dr. Debra Patt told lawmakers.

The bill was reported favorably without amendments in a 9-0 vote to the full Senate. It already passed the House. Buckingham said she would entertain amendments to the bill after discussion with other senators on the committee. If the bill is amended, it would go back to the House for approval before it could advance to the Governor’s desk.

The last day of the legislative session is May 31.

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