State legislators forming committee to study health insurance for employees

The Mississippi State and School Employees' Health Insurance Plan will be the focus when a health insurance study committee meets in the coming months, according to Sen. Walter Michel.

As chairman of the Senate Insurance Committee, Michel is automatically a member of the study committee. So is the chair of the House Insurance Committee, Jerry R. Turner of District 18.

Hob Bryant of District 7, chair of the Senate Public Health and Welfare Committee, and Sam Creekmore IV of District 14, chair of the House Public Health and Welfare Committee, are also automatically members of the study committee.

Lt. Gov. Delbert Hosemann and Speaker of the House of Representatives Jason White will make additional appointments to the study committee, said Michel, who expects those could include physicians and representatives of state medical associations.

The cost of providing health insurance for the state's 180,000 employees has risen 5 percent to 6 percent annually and the study committee would like to gain information during its meetings that would be helpful going into the 2026 legislative session, said Michel, who represents District 25.

Information gathered during the study committee meetings could also be useful to organizations outside state government that offer health insurance for employees, he said.

In other insurance-related matters, Michel was responsible for the prior authorization bill that the Mississippi Legislature passed in 2024, and the National Council of Insurance Legislators asked him to offer that to the council as a model bill.

The council will meet in July in Chicago and amendments to the Mississippi law will be offered for consideration, he said.

Insurance companies like to have consistent legislation in all states, and the National Council of Insurance Legislators works to provide that, he said.

The prior authorization law, which took effect on July 1, 2024, does not require prior authorization for emergency services.

Prior authorization is the process by which a health insurance issuer determines the medical necessity and medical appropriateness of an otherwise covered health care service before the rendering of such health care service.

For urgent services or procedures, insurance companies have 48 hours to process requests, unless a longer minimum time frame is required under federal law for the health insurance issuer and the urgent health care service at issue.

For non-urgent services, insurance companies have seven working days to process requests. Insurance companies have two business days for prior authorization requests for pharmaceutical services and products in non-urgent cases.

The law is important, Michel said, so that patients do not receive bills that surprise them, and providers get paid.

The law prohibits health insurance issuers from denying a claim for failure to obtain prior authorization if the prior authorization requirement was not in effect on the date of service on the claim.

The law requires health insurance issuers to maintain a complete list of services for which prior authorizations are required and to make any current prior authorization requirements and restrictions readily accessible and posted on their website.

By Jan. 1, 2025, health insurance issuers or their designated utilization review organizations were required to make available a standardized electronic prior authorization request transaction process using an internet webpage, an internet webpage portal or a similar electronic-, internet- and web-based system.

All health care professionals and health care providers are required to use the standardized electronic prior authorization request transaction no later than Jan. 1, 2027.

The law gave Insurance Commissioner Mike Chaney's office the responsibility for enforcing the law and establishing a fine for failure to comply with the law.

"If there's a problem, there's the opportunity for the Mississippi Department of Insurance to have a hearing and administer a fine," Michel said.