Health Care Pre-Authorization Featured Tuesday at Texas Senate Finance Committee | KTAB
AUSTIN (Nexstar) – With less than two weeks into the legislative session, Texas lawmakers spent Tuesday discussing health plans and the pre-authorization of health care coverage.
In the Texas Senate finance committee, lawmakers heard testimony on Bill 3459, a proposal touted by supporters as a plan to remove barriers to healthcare.
“For many patients, the administrative implications of these mandatory protocols translate into delays in much-needed care, poor clinical outcomes, and can sometimes prevent the patient from fully receiving medically necessary care,” the bill’s sponsor told Senate, 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 a drug or performs a procedure – and the review of use – examining the care and ensuring that they will be covered by insurance – has become ineffective, complex and burdensome and “ultimately results in many Texans being denied essential health care services.”
The legislation would require that physicians who review health plans as part of the prior authorization and use review process be licensed in Texas and practice in a specialty similar to that of the physician prescribing the medical care.
Under HB 3459, physicians for whom 80% of their pre-authorization requests were approved by the insurer in the previous calendar year would no longer need a pre-authorization for the following year.
Prior authorization was initially implemented to monitor the healthcare system to prevent fraud, waste and abuse on the part of doctors and patients.
Jamie Dudensing, RN, MPA, argued that HB 3459 would remove a layer of accountability.
âHe should have some responsibility on the back end. You should have some responsibility for fraud, waste and abuse. You should have some responsibility for this quality of care, and you should have some responsibility for the measures that have been developed by the medical community to follow, âsaid Dudensing, CEO of the Texas Association of Health Plans.
A breast medical oncologist testifying on behalf of the Texas Medical Association argued that the bill would reduce wait times for care.
âPatients and physicians would like to reduce the intrusive impact of prior authorizations on the patient-physician relationship, because obviously I make very specific decisions for the patients I serve, and if I do so regularly, and consistently, appropriately. , I shouldn’t be held to that same burden, âDr. Debra Patt told lawmakers.
The bill was reported favorably without amendments in a 9-0 vote in the full Senate. He has already passed the House. Buckingham said she would accept amendments to the bill after speaking with other senators on the committee. If the bill is amended, it will be sent back to the House for approval before it can be presented to the governor’s office.
The last day of the legislative session is May 31.