A new state law in New Hampshire is set to improve the process of prior authorizations, starting next year. This legislation establishes clear deadlines for insurers to respond to prior authorization requests: within 72 hours for urgent cases—or sooner if the patient’s condition demands it—and within seven days for non-urgent procedures when requests are submitted electronically. If insurers fail to meet these deadlines, the requested procedure will be automatically approved. The law mandates that insurers use qualified medical experts to determine whether a procedure is medically necessary, ensuring that these decisions are grounded in evidence-based practices.
A 2023 survey by the health policy organization KFF highlighted the need for such reforms, with 16% of insured adults reporting that their insurance had been delayed or denied prior approval for treatment, services, or medications in the past year. This figure rose to 26% among those seeking mental health treatment.
AHIP, a national advocacy group for providers of healthcare coverage and services, supported the final version of the bill, noting that it would retain the benefits of prior authorization while encouraging more providers to submit requests electronically, ultimately improving the process for both doctors and patients.
While the new law does not apply to government insurers like Medicare and Medicaid, the federal Centers for Medicare and Medicaid Services (CMS) issued new rules in January that similarly require Medicare and Medicaid to process urgent prior authorization requests within 72 hours and all others within seven days.