A bill approved by a key Senate committee Tuesday would allow the Hawaii Medical Service Association to continue its controversial new policy of requiring doctors to get pre-authorization from a mainland company before ordering imaging tests for patients.
House Bill 2740 as approved by the state House would have prohibited health insurers from requiring pre-authorization that causes “undue delays” in patient care, and would have made the insurance company legally responsible if any patient injuries were caused by pre-authorization delays.
“There have been too many cases that have stretched out for four or five days and longer — several weeks in some cases. You don’t get good outcomes when things are delayed that long.”
Christopher Flanders
HMA executive director
However, Senate Commerce, Consumer Protection and Health Chairwoman Ros-alyn Baker announced Tuesday she is rewriting the bill so that HMSA’s pre-authorization process can continue.
The new draft will specify that “nothing in this measure shall be construed to prohibit use of pre-authorization for medical treatment and services, or conflict with current contracts,” Baker said.
“So there is no question, we are deleting the liability provisions in this measures, as the chair indicated she would early on,” Baker added, referring to herself. “This is the best the chair could do given all of the moving parts, but we’ll see what (the Judiciary Committee) has to say, and what other people have to say” after they review the new draft.
HMSA on Dec. 1 began requiring all physicians in its network to go through Arizona-based National Imaging Associates Inc. to approve diagnostic imaging exams, including MRIs, CT scans and other cardiac-related procedures.
The new policy is an effort to avoid unnecessary testing and to reduce costs. Before HMSA adopted the new policy, most doctors were given a waiver that allowed them to skip the pre-authorization step.
HMSA, the state’s largest health insurer, contends that the policy is necessary because Hawaii’s imaging costs are about 9 percent higher than the national average in commercial markets for people who have insurance through their employers.
Doctors complained that the new policy is delaying critically needed imaging tests and that those delays could harm patients.
“There have been too many cases that have stretched out for four or five days and longer — several weeks in some cases,” said Christopher Flanders, executive director of the Hawaii Medical Association. “You don’t get good outcomes when things are delayed that long.” The HMA is an organization that represents doctors.
Flanders said the doctors are disappointed Baker removed the language making HMSA legally responsible for any harm suffered by patients because of pre-authorization delays.
“We think with prior authorization programs that we need to emphasize the quick turnaround, the ability to diagnose in a timely fashion, and if that’s impeded, then we think there ought to be some kind of risk taken on the part of the insurers,” Flanders said.
Flanders and other physicians said they are not trying to eliminate prior authorization, and that imaging tests should be screened for medical appropriateness. However, the HMA wants a less “extensive” prior authorization program than HMSA implemented last year, he said.
The HMA also wants time limits on how long the insurer or its agent has to make decisions, and “to hold them accountable for any injuries or damages that occurred because of the extension of the prior authorization,” he said.
House Bill 2740 goes to the Senate Judiciary and Labor Committee for further consideration.
