New York governor takes aim at prior authorization: 5 notes – Becker’s Payer Issues

Democratic Gov. Kathy Hochul proposed a number of initiatives Jan. 13 that intention to shore up healthcare in New York state.

Affordability has been a urgent concern amongst New Yorkers. Within the information launch, Ms. Hochul stated she’s going to direct the state’s Division of Well being to barter with federal officers over Important Plan protection losses affecting 450,000 residents. She additionally addressed how 140,000 New Yorkers will face a 38% improve in premiums as a result of expiration of enhanced ACA subsidies.

Prior authorization reform was one other precedence for Ms. Hochul. Going into 2026, a number of states have been focusing on turnaround occasions for prior authorization choices. For Ms. Hochul’s initiative, transparency is the cornerstone.

“These reforms will enhance entry to care by eradicating pointless administrative burdens on suppliers and ensuring essential care is neither delayed nor denied,” the discharge stated.

Listed here are 5 proposed prior authorization reforms payers ought to know:

1. Ms. Hochul stated she would require formularies — drug lists that insurers cowl — to be publicly accessible in a “commonplace, accessible format.”

2. Ms. Hochul additionally stated she goals to increase continuity of care “from 60 days for life-threatening situations or late-stage being pregnant to 90 days for all well being situations and the complete postpartum interval.”

3. Prior authorizations addressing sure persistent situations would have longer validity, in response to the governor.

4. Well being insurers can be required to share extra knowledge on claims processing. Some knowledge factors embody the frequency claims are topic to prior authorization, in addition to the frequency of their denials.

5. New York would launch a public schooling marketing campaign to assist customers and suppliers as they face insurance coverage points.