by NH Senator Denise Ricciardi
THE HIGH COST of all access to health care is a major concern for many working families and small businesses. That is why I introduced SB 561.
Decades ago, the concept of prior authorization, or pre-certification, emerged to curb unnecessary and costly tests or procedures. Originally focusing on high-cost treatments like cancer care, its intent was to ensure necessary and cost-effective health care. However, the landscape has shifted, with insurers now mandating prior authorization for routine medical procedures such as basic imaging and prescription refills.
A 2021 American Medical Association survey revealed that 40% of physicians employ staff exclusively dedicated to prior authorization, driving up costs for patients and insurers alike. Delays and denials, at times, prevent patients from accessing crucial care.
While the federal government has proposed changes in 2026 to expedite prior authorization decisions, it falls short of meeting the needs of Granite State residents. As the state senator for District 9, my commitment has always been about finding solutions that enhance the lives of my constituents. SB 561 will help Granite Staters who find themselves in a frustrating limbo, awaiting approval from insurance companies for essential medical care.
SB 561 aims to dismantle barriers to patient care by streamlining prior authorization timelines, enhancing transparency, and establishing a clear peer-to-peer process. The bill mandates insurance carriers to make urgent prior authorization determinations within three days and non-urgent cases within seven days. This ensures that patients and providers promptly receive the information necessary for insurance coverage and care planning.
Furthermore, the legislation introduces a peer-appeal resource, fostering improved communication with medical providers. This ensures that insurance carriers base their determinations on medical research and best practices, ultimately prioritizing the patient’s well-being.
SB 561 also prioritizes transparency and accountability by compelling insurers to disclose more data about approvals, denials, and timelines. To craft this legislation, I convened a diverse group of stakeholders, including bill sponsors, health care leaders, and the state Department of Insurance. Over the summer, we collectively addressed constituent concerns and navigated the challenges within the current prior authorization system.
In the legislative realm, it’s truly a remarkable day when stakeholders from both provider and carrier sides unite. As we all work together, advocating in the best interests of patients, members, and constituents, we forge a path forward that benefits us all.
I want to thank the New Hampshire Medical Society, the New Hampshire Hospital Association, the insurance carriers, and the Department of Insurance. Their collaborative efforts helped in creating this piece of legislation.
Today, with SB 561, we take a significant step towards a more efficient, transparent, and patient-centered prior authorization process, enhancing health care delivery in the Granite State.
SB 561 will provide better access to needed care for all Granite Staters.