VIDEO: House Endorses Bill to Speed Up Health Care, Limit ‘Prior Authorization’

      The House has voted for the second straight year to decrease wait times for Missourians seeking medical care, while increasing the quality of and access to that care and lowering costs. 

Representative Melanie Stinnett (Photo: Tim Bommel, Missouri House Communications)

      Representatives voted overwhelmingly last week to send to the Senate House Bill 618, dealing with prior authorization. 

      “‘Prior authorization’ is a term used to describe the process for requiring healthcare providers to request approval before providing a healthcare service,” explained bill sponsor Melanie Stinnett (R-Springfield)

      She said it is a practice that is, “Getting in the way of health care for every day Missourians.”  

“I could go through all the components of prior authorization and all the pieces that are required but ultimately the process requires time, and it includes delays for patients.  We have data from different sources that says that healthcare providers, that physicians are spending sometimes 14 hours of their week doing prior authorization tasks, and that’s time that they could be spending with patients, that’s time that they could be providing care to Missourians.”

      Stinnett’s bill would free healthcare providers from having to seek prior authorization from insurance providers for a given procedure for six months, if at least 90 percent of its previous requests for authorization have been approved.  The bill also lays out how a provider could maintain that exemption status through ongoing evaluations. 

      Stinnett, who is a speech-language pathologist, said the current process is giving power and authority to insurance companies.  She recalled one case in which an insurer was denying care for one of her patients, based on the finding that the patient’s hearing loss was not congenital. 

      “Funny thing is, there’s not a diagnosis code for congenital hearing loss, and so there was no way for me to indicate that readily, and then going through the appeals trying to provide letters from the neonatologist and get that from the hospital and get that information from the ENT, and it was just a fight all along the way. I, as the provider, chose to go ahead and provide care uncompensated until I won that battle but it was months of a battle.”

      Other legislators who work in medical fields joined Stinnett in expressing why her legislation is needed. 

      Springfield Democrat Jeremy Dean worked in several healthcare clinics in his district.  He said legislators hear often that Missourians want more time from their physicians.

Representative Jeremy Dean (Photo: Tim Bommel, Missouri House Communications)

“We go and see our doctor hopefully one time a year if we’re healthy and it seems like we’re in and out, the doctor doesn’t have time to talk to us, and I think that this is one of the prime reasons that has caused doctors to feel like they are so stretched thin for time, is because they’re doing so many other things to please our insurance companies,” Dean told Stinnett during debate in the House. 

“Thank you so much for bringing this bill forward.  It’s absolutely going to help our constituents and the people of Missouri.”

      Representative Gregg Bush (D-Columbia) is a registered nurse.  He said there is a “crisis” in Missouri and the rest of the U.S., of individuals seeking care from medical professionals being impeded by insurance companies.

      “Right now in each one of our districts there is somebody who is sick and injured who’s going into a hospital, who’s going into a clinic, and instead of the clinician or a healthcare provider being able to treat our citizens who are sick and injured, [that provider is] on the phone with someone far away who’s never even laid eyes on the patient, who’s never even been around the person who is sick and injured, and is telling our health care providers what they can and can’t do.  Mr. Speaker I trust our education, being able to treat the patient in front of us, and that’s why I’m urging the whole body to vote ‘yes’ on this bill.”

VIDEO: An exchange between Representatives Gregg Bush (D-Columbia) and Melanie Stinnett (R-Springfield) illustrates why they believe her House Bill 618 should pass:

“Prior authorization is literally red tape in healthcare,” said Rolla Republican Tara Peters.  “When we’re sick and when we are trying to find out what’s wrong with us to try to get treatment we should not be waiting on insurance companies to make those decisions for us.”

      “We recently heard a story about a person under anesthesia that the insurance company would only pay so much, and they were actually under the anesthesia and had to get authorization to get more.  I mean, what kind of absurdity is that?” Peters asked.  “Let’s do away with barriers that are hindering our healthy outcomes for our Missourians and let’s pass House Bill 618.”

      Ozark Republican Jamie Gragg talked about his own experience as a patient with breathing issues related to allergies which used to result in him frequently being hospitalized for days at a time. 

Once he was diagnosed, doctors were able to put him on medication that kept him out of the hospital “however, every year I have to go through a preauthorization, and there are times where I am off the medication for a couple of months because the preauthorization is such a headache.  It’s a pain, because there are times when I’m off the medication for a couple of months that I have issues with breathing again.”

“I’m not unique,” Gragg told his colleagues.  “This is what people go through, and it’s even more detrimental with some other medications they have to wait for, so this is a very much needed bill.”

      Though much of the sentiment expressed during debate suggested that this legislation would benefit patients over insurers, Stinnett said she believes both sides will win if it becomes law.

Representative Gregg Bush (Photo: Tim Bommel, Missouri House Communications)

      “When providers know that their prior auth status is based on a 90 percent approval rating, they’ll be less likely to test the waters and see what they can get approved.  There’ll be streamlining of what services are provided, and the motivating factors mentioned previously will be neutralized.”   

“Ultimately,” Stinnett continued, “what will win out is the best interest of patients, and every Missourian will be positively impacted.”

      The House voted 148-4 to send that proposal to the Senate.  Similar legislation last year was voted out of the House 146-6, but it did not receive a committee hearing in that chamber.

Plan on Governor’s Desk would Allow Investments by Rural Hospitals

      A plan to bolster Missouri’s rural hospitals’ financially stability is one of the measures awaiting action from the governor after the close of the legislative session earlier this month.

Representative Tara Peters (Photo: Tim Bommel, Missouri House Communications)

      The proposal from Representative Tara Peters (R-Rolla) would expand the authority of rural hospital boards to invest funds that aren’t used for immediate obligations or hospital operations. 

      It was one of several measures she proposed this year aimed at supporting rural healthcare.   

      “We have small, rural hospitals closing all over the state.  This was an opportunity for them to expand that so they can use more of that money on other investment opportunities so they can get more money back, to stay afloat.”

      “It’s very important for our smaller hospitals in districts like mine to stay open so that we can provide great healthcare for the State of Missouri,” Peters said. “This is just one tool to allow them to stop operating in the red.”

      Peters said for many years rural hospitals have been barred from investing non-operating funds.

      “It was explained to me that it was put in the statute a long time ago because one hospital, I guess, had invested all of its money, 100 percent of it, in pork bellies, and at that time all the pork bellies went under and they lost all their money, so there were limitations put on the percentage of the amount of money that hospitals could invest, to not lose it all,” said Peters.

      The hospitals had been asking for full spending authority, but that wasn’t feasible to House lawmakers. 

      “They didn’t get everything they wanted.  Obviously they would have liked the opportunity to have 100 percent but the committee who heard that negotiated, and this is allowing them to take 15 percent to do a variety of stocks, bonds, and money market investments.  It’s not 100 percent but it’s a lot more than what the state statute was allowing them to do in the first place.  I’m hoping that by doing that they can recoup some of that money and hopefully get some gains, and use that money to keep in operation.”

      Peters said there was good reason for the prohibition on investing that was put in place, but with the passage of time and with rural hospitals struggling to stay in operation, that law was out of date.

      “We need to make sure that our state’s statutes are actually supporting the causes of our local hospitals, and any entity, so that we can operate to the full extent, so again that we can benefit Missourians and not operate in archaic times where the state statutes aren’t really benefitting out establishments.”

      The language was sent to the governor as part of Senate Bill 1359.  He can choose to sign it into law, veto it, or allow it to become law without taking any action.