Prior authorization, sunscreen bills become law

ISMA was pleased to participate in the signing of HEA 1143 by Gov. Eric Holcomb on May 3. Diverse stakeholders, including ISMA, Anthem, Inc., the Indiana Hospital Association and The Cancer Care Group collaborated on the bill to make the prior authorization process more transparent and accountable. Many thanks to the bill’s author, Rep. Donna Schaibley, co-authors Rep. Martin Carbaugh, Rep. Terri Jo Austin and Rep. Matt Lehman, and sponsors Sen. Liz Brown and Sen. Lonnie Randolph. Also involved were ISMA President John P. McGoff, MD; Alexander Choi, MD; and Brad Barrett, MD.
Two important bills initiated by ISMA were signed into law Thursday by Gov. Eric Holcomb. Both become effective on July 1, although certain provisions won’t apply until later.

The first bill, HEA 1143, creates greater transparency and accountability in the prior authorization (PA) process. It includes several key provisions.
  • Beginning Sept 1, a health plan must disclose any new requirement for PA to providers at least 45 days before the requirement becomes effective, including publishing the disclosure conspicuously on the health plan’s website.
  • A health plan must respond to an urgent care PA request within 72 hours of receiving it and respond to a non-urgent request no more than seven days after receipt. If a request for PA is denied, the health plan must state the specific reason for the denial. This provision applies to any PA request delivered to a health plan after Dec. 31, 2019.
  • If a health plan has granted a PA request for a service, it cannot deny payment on a claim for that service unless the claim or request contains fraudulent or materially incorrect information or the patient was not covered under the health plan on the date the service was provided. This applies to any request for PA delivered to a health plan after Dec. 31, 2019.
Another bill signed Thursday, SEA 24, allows students to possess and use topical, non-aerosol sunscreen at public and charter schools and school activities beginning July 1.