New insurance procedure should prepare patients for medical bills Michel says (2024)

Sen. Walter Michel of District 25 wants to spread the word that a new law streamlines the prior authorization process that comes into play for healthcare patients and providers.

Under the new law that takes effect on July 1, prior authorization is not required for emergency services.

Prior authorization is the process by which a health insurance issuer determines the medical necessity and medical appropriateness of an otherwise covered health care service before the rendering of such health care service.

For urgent services or procedures, insurance companies have 48 hours to process requests, unless a longer minimum time frame is required under federal law for the health insurance issuer and the urgent health care service at issue.

For non-urgent services, insurance companies have seven working days to process requests. Insurance companies have two business days for prior authorization requests for pharmaceutical services and products in non-urgent cases.

Gov. Tate Reeves vetoed a similar bill last year but allowed this year's version to become law without signing it.

In a social media post, the governor stated: "I am allowing Senate Bill 2140 to become law because I agree that it is a significant improvement over its predecessor and that reform of the prior authorization process is much needed. That being said, I cannot put my signature on this bill because of its potential effects on the premiums paid by state employees."

Michel said the law is important so that patients do not receive bills that surprise them, and providers get paid.

The law prohibits health insurance issuers from denying a claim for failure to obtain prior authorization if the prior authorization requirement was not in effect on the date of service on the claim.

The new law requires health insurance issuers to maintain a complete list of services for which prior authorizations are required and to make any current prior authorization requirements and restrictions readily accessible and posted on their website.

By Jan. 1, 2025, health insurance issuers or their designated utilization review organizations must make available a standardized electronic prior authorization request transaction process using an internet webpage, an internet webpage portal or a similar electronic-, internet- and web-

based system.

All health care professionals and health care providers are required to use the standardized electronic prior authorization request transaction no later than Jan. 1, 2027.

The law gives Insurance Commissioner Mike Chaney's office the responsibility for enforcing the law and establishes a fine for failure to comply with the law.

"If there's problem, there's the opportunity for the Mississippi Department of Insurance to have a hearing and administer a fine," Michel said.

Michel, chair of the Mississippi Senate's Insurance Committee, is speaking to groups throughout the state about the new law regarding prior authorization and other new ones that have to do with insurance.

"It was a busy year for the Insurance Committee," he said. "We had 40 bills filed."

Another new law prohibits health benefit plans from requiring step therapy or first-fail protocols before providing coverage of certain prescription drugs to treat advanced, metastatic cancer and the symptoms or side effects associated with it or its treatment.

The new law will allow the patient to receive the most effective drug rather than having to first try drugs that are ineffective, Michel said.

The law prohibiting step therapy includes a repealer, which means it will cease to be in effect after two years, Michel said. The law will go into effect on July 1 and be repealed on June 30, 2026.

"What we're hoping is that by going to the most effective therapy first, we're going to save money," he said.

Also passed during the 2024 session was the Living Donor Protection Act, which goes into effect on July 1. It bans life, disability and long-term care insurance providers from discriminating against living organ donors by refusing to insure them, limiting their coverage or forcing them to pay a different rate or premium because they are organ donors, from declining or limiting coverage under any policy and discriminating against such an individual solely due to the status of being a living donor.

"We made it clear that in Mississippi if someone gives a kidney to someone, we don't want them to lose their medical coverage," Michel said.

Also passed during this year's session was a bill that allows counties, municipalities, and school districts to pool their risks and negotiate for the purchase of property insurance so they can establish a self-insurance fund or self-insurance reserves or any combination of those.

"The Mississippi Triage,Treat and Transport to Alternative Destination Act," a bill that was also passed this year, increases how much insurance companies must pay ambulance firms for services provided.

Under the act, third-party payors are required to pay for treatment in place when a patient is not transported to a hospital. "We made it such that an ambulance service should get paid for treating someone in place, even if they're not taken to a hospital," Michel said.

The act also re-aligned the payment rates for ambulance service close to Medicare rates, he said.

Another new law will make it possible for nonprofit agricultural membership organizations such as Mississippi Farm Bureau to provide healthcare insurance for its members and their families, Michel said.

"Farm Bureau will start its own health benefits plan," he said. "They'll run the program just like a self-funded plan. The premiums will go into a fund and they'll be used to pay claims. It will use a third-party administrator."

Michel said it costs $35 to become a member of Farm Bureau and he plans to join and checkout the healthcare insurance.

Allowing nonprofit agricultural membership organizations to provide healthcare insurance for their members will help make additional healthcare plans available since the Legislature did not pass Medicaid expansion, he said.

Anther bill concerning insurance that passed created the Peer-to-Peer Car Sharing Program Act, Michel said.

The act outlines the business of sharing vehicles for financial consideration and and sets forth vehicle insurance requirements.

The act provides Chaney with the authority to administer and enforce the provisions of the act.