UPDATE FROM THE LEGISLATIVE CHAIR

MEOTA strives to keep its membership informed and involved in any legislative issues pertaining to occupational therapy. Please check back here for updates, and contact us with any concerns you may have. MEOTA has our own lobbyists in Augusta- do you have an issue you'd like brought to their attention? Let us know!

A brief update from our Legislative Chair:

CMS released the final rule on January 18, 2024 impacting the prior authorization process for Medicare Advantage plans, state Medicaid and CHIP fee-for-service programs, Medicaid managed care plans and CHIP managed care entities, and Qualified Health Plan issuers on the Federally Facilitated Exchanges.

MEOTA recently worked with the PT association to address prior authorizations and getting a bill passed that requires private insurers to provide at least 12 visits initially.

Highlights to the Prior Authorization Process: 

• Requires payers to send prior authorization decisions within 72 hours for expedited requests and seven calendar days for standard requests; 
• Requires payers to provide a specific reason for denied prior authorization decisions; and
• Requires payers to publicly report certain prior authorization metrics annually (e.g. list of all items and services that require prior authorization and percentages of standard prior authorization requests that were approved and denied aggregated for all items and services.) 

The rule also requires impacted payers to build and maintain application programming interfaces (API) that automate the process for providers to determine whether a prior authorization is required, identify prior authorization information and documentation requirements, and facilitate the exchange of requests and decisions.