Prior authorization reform amended in Mississippi House, bill heads back to Senate

• On Thursday, the Mississippi House of Representatives amended the Senate’s original bill addressing prior authorization reforms. See what was changed.

Lawmakers continue to work towards reforming the prior authorization process between doctors and insurance companies.

On Thursday, the Mississippi House of Representatives amended the Senate’s original bill with a strike all and passed their bill unanimously.

“Prior authorization” mandates that doctors seek insurance provider approval for non-emergency procedures. These approvals are divided into urgent and non-urgent categories. Insurers claim that this process is vital in ensuring the necessity of treatments as well as looking for the most cost-effective way to provide medical care.

Physicians have complained about the lag in the process as well as the inadequacy of the staff they are often referred to during an appeal process if a request is denied.

Upon arriving in the House, three changes were made to the bill.

The House approved a second strike-all amendment that changed the 24-hour requirement for emergent requests to 48-hours and extended the time frame for non-emergent requests from five working days to seven. The chamber also removed the physician requirement for initial approval.

“One reason for that is to keep down the costs for the insurance company so we don’t pass on those costs to the consumer and make it more efficient for them to get a response back,” said Representative Sam Creekmore (R) who presented the bill.

He added that doctors are not always readily available to approve requests in a timely manner.

Senate Bill 2140, authored by Senator Walter Michel (R), addresses both concerns. That legislation does the following:

• Requires insurance companies to provide a comprehensive list of treatments that will require a prior authorization.

• Changes the time frame for approval for both urgent and non-urgent procedures.

• Establishes a web portal for submission and approval of a prior authorization.

• Places the Mississippi Department of Insurance as the overseeing agency of the portal.

• Includes Medicaid and the state health plan.

Due to the changes made in the House, the bill will return to the Senate for additional work. Senator Michel said he plans to study the changes and determine if he will concur or invite conference on the bill.

The issue was first brought forward during the 2023 Legislative session. While the bill was passed nearly unanimously in both chambers, it was vetoed by Governor Tate Reeves (R) who shared concerns regarding oversight of the web portal and regulations. However, he commended lawmakers for trying to tackle the problem.

Insurance Commissioner Mike Chaney (R) has expressed concerns regarding possible drug costs, particularly for the state health plan, Medicaid, and Medicare Advantage plans.