Gov. Mills signs Gratwick bill to require that insurance companies conduct timely, fair medical reviews

Posted: June 13, 2019 | Senator Gratwick

AUGUSTA – On Thursday, a bill introduced by Sen. Geoff Gratwick, D-Bangor, was signed into law by Gov. Janet Mills. The new law, LD 705, “An Act Regarding the Process for Obtaining Prior Authorization for Health Insurance Purposes,” will require insurance companies to conduct prior authorizations in a timely and fair manner. A prior authorization is a practice used by insurance companies to review a treatment option for an individual patient to determine whether that treatment can be covered.

“Ensuring that decisions about coverage for a given treatment are done in a timely, fair manner is critical to ensuring that the needs of patients come first in our health care system,” said Sen. Gratwick. “I’m thankful to the governor for her support of this measure, which will make a real difference for patients and providers alike.”

LD 705 will address unnecessary delays in treatment by decreasing the time allowed for insurance companies to respond to a prior authorization request and eliminating language that permits insurance companies to delay treatment while they acquire more information. It also exempts prescriptions for substance use disorder from the need for prior authorization and requires secure, confidential transmission of prior authorization results.

A recent survey of Maine Medical Association members highlighted the challenges presented by the prior authorization process. Maine physicians overwhelmingly reported that the burden of obtaining prior authorizations was “high or extremely high.” They felt that the process had a significant negative impact on their practice, without improving patient care.

LD 705 will take effect 90 days after the Legislature adjourns sine die.