Nov. 07, 2022

HARRISBURG – Legislation originally introduced by Rep. Aaron Bernstine (R-Beaver/Butler/Lawrence) to streamline the process for prior authorization of medical services in Pennsylvania was signed into law by Gov. Tom Wolf.

“Currently, the prior authorization procedure is often an inefficient process that increases costs for providers, their patients and all policy holders,” said Bernstine. “The lack of standardization of paperwork; lack of transparency, accessibility and consistent application of prior authorization requirements, restrictions and amendments; and lack of electronic submission capability all contribute to the impaired delivery of quality health care to our constituents.”

Specifically, Senate Bill 225, now Act 146 of 2022, will improve transparency, accessibility and consistent application of prior authorization by including a standard definition. It will also significantly streamline the process by requiring insurers to make available an electronic communications network that permits prior authorization requests to be submitted electronically, and authorizations and adverse determinations to likewise by returned electronically.

Pennsylvania will now join 44 states that already have external review authority. In addition, the new law also lays out standards for the review of prior authorization requests and confirms in state law that there may be no prior authorization for emergency services, consistent with the Federal No Surprises Act.

“Improved patient care will result from requiring consistent response times and processes with prior authorizations, adverse determinations and appeal procedures, including external review by insurers,” said Bernstine.

The major provisions of the law will take effect beginning in January 2024.

Representative Aaron Bernstine
10th Legislative District
Pennsylvania House of Representatives

Media Contact: Rick Leiner
717.260.6437 (office), 717.497.8478 (cell)