Prior Authorization Reform 

The Michigan State Senate has recently held to committee hearings regarding prior authorization. SB 612 will go a long way towards easing the confusion and delays providers and patients encounter due to prior authorization requirements. The MOA urges our members and supporters to take action. Use the links on this page to review the issue. Then, contact your legislators and let them know you support SB 612. Our patients deserve timely care and as physicians, we can use more time to treat our patients and less time dedicated to navigating complex requirements.
Be sure to share the link to “approvemycare.org” with friends and colleagues. Your support is greatly appreciated.
- Craig Glines, DO, MSBA, FACOOG
President Michigan Osteopathic Association

Restrictive prior authorization requirements often force patients to delay much-needed care and put a strain on the physician-patient relationship. These requirements also put a strain on a physician's practice - requiring additional administrative work to get important procedures and prescriptions approved for patients. That means more money going towards administrative work instead of patient care. 

That's why we need you to reach out to your State Senators and ask them to support Michigan Senate Bill 612. This legislation would go a long way toward streamlining the prior-authorization process by making it more transparent and creating strict timelines for approval. The bill achieves this goal by requiring insurers to: 

- Post prior-authorization requirements on their public website. These requirements should be described in detail, use easily understandable language, and be based on peer-reviewed clinical review criteria. 

- Post statistics regarding prior-authorization on their website.

- Ensure that any adverser determination is made by a licensed physician who practices in the same specialty as the provider who would normally perform or prescribe the treatment in question.

- Respond to "urgent" requests within 24 hours and "non-urgent" requests within 48 hours. If requests are not responded to in that time frame they are considered granted 

Michigan Senate Bill 612 will not solve every problem associated with prior authorization, but it will go a long way to alleviating the burden it places on your practice and your patients. Write your Senator today and ask them to support SB 612!

ApproveMyCare

Be heard

Prior Authorization requirements and step therapy can delay medical procedures and cause complications in patient access to quality care. As a physician, health care provider, patient or family of a patient, if you have experienced delay or denial of medical care due to insurance requirements we want you to be heard. If you would like to share your story—either in writing, audio or video—we want to hear from you. 

Share your story of delayed healthcare

 

 

 

UPDATE Feb. 6, 2020:
The  hearings on SB 612 by the Senate Committee on Health Policy & Human Services have been very successful in educating the committee members and public about the challenges with current prior authorization and its impact on access to health care. Patients have shared compelling personal stories on how these current practices are delaying and denying care.  We hope continued patient stories will move the needle for successful discussions and negotiations in the coming weeks.
- Kevin McKinney, MOA Governmental Liaison


Load the Text Version Load the PDF Version SUMMARY OF INTRODUCED BILL IN COMMITTEE (Date Completed: 1-29-20)
This document analyzes: SB0612
 
Contact Your Legislator regarding SB 612

FDA identifies harm reported from sudden discontinuation of opioid pain medicines and requires label changes 

to guide prescribers on gradual, individualized tapering

TOPIC: Opioid Pain Medicines: Drug Safety Communication - Harm to Patient Reported From Sudden Discontinuation of Opioid Pain Medicine
AUDIENCE: Patient, Health Professional, Pain Management, Pharmacy
ISSUE: FDA has received reports of serious harm in patients who are physically dependent on opioid pain medicines suddenly having these medicines discontinued or the dose rapidly decreased. These include serious withdrawal symptoms, uncontrolled pain, psychological distress, and suicide.

Rapid discontinuation can result in uncontrolled pain or withdrawal symptoms. In turn, these symptoms can lead patients to seek other sources of opioid pain medicines, which may be confused with drug-seeking for abuse. Patients may attempt to treat their pain or withdrawal symptoms with illicit opioids, such as heroin, and other substances.

Read FDA Recommendations

Revised FAQ on Michigan Opioid Laws

MARCH 6, 2019 – The Michigan Department of Health and Human Services (MDHHS) and the Michigan Licensing and Regulatory Affairs (LARA) have released an updated ‘Michigan Opioid Laws, Frequently Asked Questions’, document.

 Changes to the document include additional guidance specific to Health Profession Subfield Licensees and can be found in the following location in the PDF:

  • Page 7, FAQ #5
    • Subsection “c” added.
  • Page 13, FAQ #9
    • Subsections “c” and “d” added. Additionally, the links to Michigan statute that were previously broken have been fixed.

 Additionally, the links to Michigan statute that were previously broken have been fixed. Click on the button below to access the PDF file, Michigan Opioid Laws FAQ.

LARA Michigan Opioid Laws FAQ (PDF)

LARA Updated Regulations: Bona Fide Prescriber-Patient Relationship

Bona Fide Relationship Requirement Law. Public Act 247 of 2017, MCL § 333.7303a(2), requires that except as provided in exceptions detailed in administrative rules, a prescriber must be in a bona fide prescriber-patient relationship with a patient before prescribing a schedule 2-5 controlled substance ("CS"). The Michigan legislature delayed the effective date of the bona fide prescriber-patient relationship requirement to the earlier of (a) March 31, 2019, or (b) the date administrative rules describing the exceptions to the requirement are promulgated. Public Act 247 also requires the prescriber to provider certain follow-up care to the patient to monitor the efficacy of the CS in treating the patient's medical condition. Failure to comply with the bona fide relationship requirement is considered professional misconduct and may subject the prescriber to professional discipline.

Effective Date. The Michigan Department of Licensing and Regulatory Affairs ("LARA") has now published a rule, effective January 4, 2019, describing exceptions to the bona fide prescriber-patient relationship requirement. Promulgation of this rule means that the bona fide prescriber-patient relationship requirement of MCL § 333.7303a is in effect as of January 4, 2019, for all practitioners who prescribe schedule 2-5 CS.
Link: LARA Updates: Bona Fide Prescriber-Patient Relationship

 

Multiview advertisement

acemapp

ACEMAPP connects employers with professionals with job opportunities in the Great Lakes region. Employers include private practices, hospitals, health systems, community health centers, federally qualified health clinics, specialty practices, prison health, and telemedicine providers. Available locations range from rural to urban areas, and many opportunities qualify for loan repayment.
Search Jobs
Post Jobs

Opioid Prescribers' Legislative Alert

On December 27, 2017, the Lieutenant Governor signed into law several new requirements aimed at combating the opioid epidemic. The MOA is part of a coalition that is working with the Department of Health and Human Services (MDHHS) to provide input from healthcare professionals in regards to the laws, regulations and systems used by prescribers. 

For MOA members, a page has been created with an overview, a link to a summary (PDF) and a link to a survey designed to get feedback from the MOA membership.

Opioid Alert page (MOA login page)
Michigan Automated Prescription System (MAPS) - User Support Manual