Prior authorizations: There's hope for change
In the pursuit of the best healthcare, there are many factors on which patients and physicians agree. If there is one topic that stands out the most that unites us, it is our mutual dislike for prior authorization requirements. Fortunately, some good news may be on the horizon.
At present, 41 states are considering or have taken action to reform prior authorization, at the request of patient and physician advocates. But revising or issuing new state laws has limited effectiveness because insurers change their authorization rules repeatedly. State-level legislation will always be a limited option, but we continue to make strides.
Groups such as the American Medical Association, American Hospital Association, Washington Committee of the American Association of Neurological Surgeons, and Congress of Neurological Surgeons, and more, support a federal-level response and are pushing Congress to pass the Improving Seniors' Timely Access to Care Act, introduced by Representative Suzan K. DelBene of Washington. Rep.
Delbene’s reform bill would require some insurers to use electronic prior authorization programs and render immediate decisions for certain prior authorization requests. Insurers would have to identify items and services for which prior authorization is required and list the documentation needed to support any request — largely a reversal of current practices.
The proposed legislation applies only to insurance companies that offer Medicare Advantage plans. Congress has more direct authority over the Medicare program than private insurance companies. The hope is that if insurers are forced to adopt new ways for their Medicare Advantage business, they will apply the same processes to their other plans.
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It will continue to be a challenge to try to legislate in a meaningful way to try to alleviate the burden on providers and patients. Please be aware of this important legislation and consider reaching out to your U.S. Representative and/or Senators as it comes up for a vote. You can sign up for alerts for this bill by visiting the congress.gov link below.
Sources:
2021 AMA prior authorization physician survey, American Medical Association