Prior Authorization Reform - What You Need to Know from Senate Bill 247
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This document outlines HAP's operational standards and procedures to comply with Michigan Senate Bill 247 prior authorization reforms, including submission channels, notification timelines, and decision timeframes for contracted and non-contracted providers.
No material clinical or coverage changes in this revision.
Provider Submission and Notification Requirements
Submission channels and outage protocol
Contracted providers must submit prior authorization requests by logging in at hap.org and selecting Authorizations. Non-contracted providers must submit requests online via hap.org/providers using the non‑contracted providers link. If authorization systems are temporarily unavailable, alerts on the provider portal and the public website will instruct providers how to submit requests during outages.
- Contracted: log in at hap.org → Authorizations
- Non‑contracted: hap.org/providers → non‑contracted providers link
- Outage protocol: portal and public website alerts will provide submission instructions
Where to view benefits requiring prior authorization
Both contracted and non‑contracted providers can view the complete list of benefits subject to prior authorization on hap.org.
- Visit hap.org to view all benefits subject to prior authorization
Notification timelines for changes to prior authorization requirements
Contracted providers will receive notice of new or amended prior authorization requirements via the secure provider portal; HAP will also post the information on hap.org. Notice periods are 60 days for non‑prescription drug benefits and 45 days for prescription drug benefits before implementation.
- Contracted providers: secure provider portal notifications
- Non‑prescription drug changes: 60 days' notice
- Prescription drug changes: 45 days' notice
- Information also posted on hap.org
Decision timeframes and auto‑approval when no action taken
If HAP takes no action on a prior authorization request, non‑urgent requests will be approved 7 calendar days from the original submission date; urgent requests will be approved if no action is taken within 72 hours of the submission date and time.
- Non‑urgent default approval: 7 calendar days from original submission
- Urgent default approval: 72 hours from date and time of submission
Key Definitions and Categorization
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