|Passed by the Senate April 27, 2013|
President of the Senate
Passed by the House April 24, 2013
Speaker of the House of Representatives
I, Hunter G. Goodman, Secretary of the Senate of the State of Washington, do hereby certify that the attached is ENGROSSED SECOND SUBSTITUTE SENATE BILL 5267 as passed by the Senate and the House of Representatives on the dates hereon set forth.
HUNTER G. GOODMAN
|Approved May 10, 2013, 11:29 a.m.|
Governor of the State of Washington
May 10, 2013
Secretary of State
State of Washington
|State of Washington||63rd Legislature||2013 Regular Session|
READ FIRST TIME 03/01/13.
AN ACT Relating to developing standardized prior authorization for medical and pharmacy management; creating new sections; and providing an expiration date.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
NEW SECTION. Sec. 1 (1) A work group is formed to develop
criteria to streamline the prior authorization process for prescription
drugs, medical procedures, and medical tests, with the goal of
simplification and uniformity.
(2) The work group shall be cochaired by the chair of the senate health care committee and the chair of the house of representatives health care committee, and membership of the work group shall be determined by the cochairs, not to exceed eleven participants.
(3) The work group shall examine elements that may include the following:
(a) National standard transaction information, such as HIPAA 278 standards, for sending or receiving authorizations electronically;
(b) Standard transaction information and uniform prior authorization forms;
(c) Clean, uniform, and readily accessible forms for prior authorization including determining the appropriate number of forms;
(d) A core set of common data requirements for nonclinical information for prior authorization and electronic prescriptions, or both;
(e) The prior authorization process, which considers electronic forms and allows for flexibility for health insurance carriers to develop electronic forms; and
(f) Existing prior authorization forms by health insurance carriers and by state agencies, in developing the uniform prior authorization forms.
(4) The work group must:
(a) Establish timelines for urgent requests and timeliness for nonurgent requests;
(b) Work on a receipt and missing information time frame;
(c) Determine time limits for a response of acknowledgment of receipts or requests of missing information;
(d) Establish when an authorization request will be deemed as granted when there is no response.
(5) The work group must submit their recommendations to the appropriate committees of the legislature by November 15, 2013.
(6) This section expires January 1, 2014.
NEW SECTION. Sec. 2 The insurance commissioner shall adopt rules
implementing only the recommendations of the work group established in
section 1 of this act. The rules must take effect no later than
January 1, 2015.