Utilization Management Bill Introduced in Senate

May, 2019

An update on the Utilization Management Bill (SB139A) - With generous legislative action grants from Northwest Rehab Alliance (NWRA) and the APTA, as well as support and direction from OPT-PAC, a coalition of provider and patient advocacy groups led by the Oregon Medical Association, Oregon Chapter of the National Psoriasis Foundation, and APTA Oregon was formed to address transparency, fairness and efficiency in prior authorization. Here is a 2019 timeline to show the progress of this bill and what is yet to come:

February, 2019

For the past 15 months the OPTA has been engaged with a coalition of patient advocacy and health care professional organizations to develop a legislative pathway to easing the burden that utilization management services place on our patients.  You have probably already heard that the OPTA received a $10,000 legislative advocacy grant from the APTA and another $10,000 contribution to these efforts from the Northwest Rehab Alliance.  Those funds and additional support directed by the OPTA Board of Directors from our retained earnings have allowed the OPTA to retain the lobbying services of Chris Parta of Parta Oregon for this effort.

SB 139 was introduced and had an initial public hearing on February 6, 2019 where OPTA member Jeff Cox testified in support of the bill.  The bill contains provisions to increase the transparency, efficiency and fairness of prior authorization programs and was well received by the Senate health care committee. Unsurprisingly, though it was strongly opposed by several payers. There are several amendments already in the works to mitigate payer concerns while still improving access to necessary care with fewer needless speedbumps to care delivery.  

Specifically, the bill would:

  • Require payers to make information about utilization management program accessible and understandable for patients and providers
  • Set timelines for review and determination on completed requests as well as parameters for peer review of denials
  • Require reporting on the number of reviews completed, approved, appealed and denied to the Department of Consumer and Business Services
  • Encourage electronic submission to decrease duplicate documentation
  • Ensure that evidence supporting the utilization management determination is current and transparent

It is important to understand the bill will only have an impact on plans that originate and are governed by Oregon statute, so plans from other states, federal payers or self-insured plans governed by ERISA cannot be impacted by changes in Oregon law.  Similar discussions are underway in DC to address these concerns on a federal level with Oregon, once again on the cutting edge of these changes.  Stay tuned for ways you can help to drive this change forward.