State Requires Prior Authorization For Advanced Imaging Services in Medicaid

SEATTLE—Washington’s Health Care Authority will require Medicaid providers to use a web-based tool to obtain prior authorization for advanced imaging services after Sept. 30.

The requirement stems from the passage by the Legislature in 2009 of E.S.H.B. 2105. Its goal was to control the escalating costs of diagnostic imaging, including MRI, CT, and PET scans. The bill instructed the HCA to convene an Advanced Imaging Work Group, composed of stakeholders and government officials, “to analyze and identify evidence-based best practice guidelines or protocols” and decision tools to implement them. It also mandated that all state-purchased health care programs—with some limited ...