The National Council of Insurance Legislators (NCOIL) has adopted the Prior Authorization Reform Model Act at its 2025 Annual National Meeting in Atlanta, Georgia.
The Model, sponsored by Mississippi Sen. Walter Michel, was approved by both the Health Insurance & Long Term Care Issues Committee and the NCOIL Executive Committee.
The Model Act is largely based on prior authorization reform legislation recently enacted in Mississippi and is intended to provide states with a framework to modernize and streamline prior authorization programs.
NCOIL said the approach is designed to introduce clearer consumer protections, reduce administrative friction and improve transparency in the prior authorization process.
If adopted by states, the Model aims to limit unnecessary third-party interference in the provider-patient relationship, prevent prior authorization requirements from undermining independent medical judgment, and establish more consistent and predictable processes for providers and patients.
Under the Model, health insurers would be required to maintain and publicly post a complete list of services subject to prior authorization, along with applicable requirements, restrictions and written clinical review criteria. Insurers would also be required to publish statistics on prior authorization approvals and denials in an accessible format. The Model calls for the use of standardized electronic prior authorization systems and sets timelines for decision-making, including a requirement that expedited requests be determined within 24 hours after all necessary information is received.
The legislation also outlines requirements for adverse determinations, including disclosure of the reasons for denial, the evidence-based criteria used, and clear instructions on appeal rights. Appeals would need to be reviewed by a physician with appropriate training, knowledge or experience related to the health care service under review. In addition, insurers would be required to report aggregated annual trend data on prior authorization activity to state insurance departments.
Rep. Michael Sarge Pollock of Kentucky, chair of the Health Insurance & Long Term Care Issues Committee, said the Model reflects extensive work by the committee over the past year and addresses one of the most widely debated issues in the health care sector. He credited Senator Michel for bringing his experience from Mississippi’s reform effort into the NCOIL process.
Michel said the Mississippi legislation benefited from multiple hearings and broad stakeholder input, and that a similar deliberative process took place during development of the NCOIL Model. He added that the Model is intended to serve as a practical resource for legislators considering prior authorization reform in their own states.
During the drafting process, NCOIL legislators and staff received input from a wide range of stakeholders, including physician groups, hospital associations, insurers, patient advocacy organizations and life sciences companies.
NCOIL President Senator Paul Utke of Minnesota said the adoption of the Model reflects the organization’s collaborative approach to insurance public policy and its focus on protecting consumer health and wellbeing.
Meanwhile, NCOIL CEO Will Melofchik added that the final Model represents a consensus outcome shaped by engagement across the committee and stakeholder community, and is intended to provide meaningful guidance for states considering reforms in this area.
