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Prior Authorization Bill Watch/Call for Action

3 Feb 2018 12:09 PM | WSMTA (Administrator)

Prior Authorization Bills

Two bills have been submitted to the legislature regarding Prior Authorization.  They are both sponsored by the Physical Therapy Association of WA  (http://www.ptwa.org/) and the WA State Chiropractic Association. (www.chirohealth.org)

SB 6157 - 2017-18


Regarding prior authorization.

Sponsors: Short, Kuderer, Rivers, Cleveland, Palumbo, Nelson, Becker, Walsh, Warnick, Van De Wege

HB 2837 - 2017-18


Regarding prior authorization.

Sponsors: Kloba, Harris, Kirby, Robinson, Appleton, Johnson, Stonier, Dolan, Macri, Maycumber, Slatter, Stanford

The Main part of the bill that will affect massage therapists is this:

2)A health carrier may not require prior authorization for initial evaluation and management visit ((or an initial)) and up to eight consecutive treatment visits with a contracting provider in a new episode of care of chiropractic, physical therapy, occupational therapy, East Asian medicine, massage therapy, or speech and hearing therapies that meet the standards of medical necessity and are subject to quantitative treatment limits of the health plan.

Notwithstanding RCW 48.43.515(5) this section may not be interpreted to limit the ability of a health plan to require a referral or prescription for therapies listed in this section.
The first hearing was on Jan 30 in the Senate Committee on Health & Long Term Care at 10:00 AM   

https://www.tvw.org/watch/?eventID=2018011418   (starting at 36:00). Please watch this to get a better idea of the issues as presented by the Physical Therapy Association.

The main comment in opposition to the bill came from Meg Jones, of the The Association of Washington Healthcare Plans her comments were in relation to the potential problem of allowing more sessions which would increase costs of health care plans, which is not a good idea in the face of a unstable health insurance market.

WSMTA suggests that you comment on the bills by going to the bill pages linked above and click on comment in the top right hand corner.  Comments should be focused on the main issues that affect client care, ie;  delay of treatment or loss of continuity of care, which are the main things the Office of the Insurance Commissioner and the Senate Committee are most concerned about.  You can post your comments and you also have the option to send them to your local representative. Focus on the efficacy of massage therapy and that they still will need a prescription in order to meet medical necessity massage therapy covered.  Note how delay in or denial of treatment may result in more opioids being prescribed.

Also take notice of the representatives that have sponsored the bill.   They are representatives that are on the side of the massage profession and will need our support at election time.

For more information on how a bill becomes a law see this  from the WA State Chiropractic Association - https://c.ymcdn.com/sites/chirohealth.site-ym.com/resource/resmgr/Files/2014_federal_regulations_WA_.pdf

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