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Prior Authorization


BILLS IN 30 STATES SHOW MOMENTUM TO FIX PRIOR AUTHORIZATION


MAY 10, 2023


4 MIN READ




KEVIN B. O'REILLY

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What’s the news: A majority of U.S. states are considering legislation to
rightsize the time-wasting, care-delaying payer practice of prior authorization.
In all, nearly 90 prior-authorization reform bills have been considered this
legislative session in 30 states, and more than a dozen are still on the table
for potential passage.


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That includes legislation in Arkansas, California (PDF), New Jersey (PDF), North
Carolina (PDF), Washington, D.C. (PDF), and Washington state.

Many of the bills draw on the AMA’s model legislation (PDF) and encompass
prior-authorization reforms to:

 * Establish quick response times (24 hours for urgent, 48 hours for nonurgent
   care).
 * Allow adverse determinations only by a physician licensed in the state and of
   the same specialty that typically manages the patient’s condition.
 * Prohibit retroactive denials if care is preauthorized.
 * Make authorization valid for at least one year, regardless of dose changes;
   and for those with chronic conditions, the prior authorization should be
   valid for the length of treatment.
 * Require public release of insurers’ prior authorization data by drug and
   service as it relates to approvals, denials, appeals, wait times and more.
 * Require a new health plan to honor the patient’s prior authorization for at
   least 90 days.
 * Reduce volume through the use of solutions such as prior authorization
   exemptions or gold-carding programs.

"The momentum behind prior-authorization reform feels powerful right now, with
dozens of bills in state legislatures this year and advocates laying the
groundwork for next year," said AMA President Jack Resneck Jr., MD. "These
efforts join major reforms at the federal level being proposed and finalized.
Policymakers and other stakeholders seem to be realizing what patients and
physicians have known for a long time—prior authorization harms patients,
undercuts clinical decision making and wastes valuable health care resources."

RELATED COVERAGE

1 in 3 doctors has seen prior auth lead to serious adverse event

The progress at the state level comes as the Centers for Medicare & Medicaid
Services (CMS) has taken action at the federal level, releasing a final
rule (PDF) last month that revises Medicare Advantage prior-authorization
program requirements. In February, the AMA and nearly 120 physician
organizations sent a letter (PDF) to CMS Administrator Chiquita Brooks-LaSure in
strong support of the proposed prior-authorization changes, and many of the
provisions have been finalized.

> Fixing prior authorization is a critical component of the AMA Recovery Plan
> for America’s Physicians.
> 
> Prior authorization is overused, and existing processes present significant
> administrative and clinical concerns. Find out how the AMA is tackling prior
> authorization with research, practice resources and reform resources.

Why it’s important: As AMA Executive Vice President and CEO James L. Madara, MD,
explained in a letter (PDF) supporting New Jersey Assembly Bill 1255, “AMA
survey data released earlier this month show that 94% of physicians report care
delays because of prior authorizations. The same survey [PDF] found that 89% of
physicians saw prior authorization as having a negative effect on their
patients’ clinical outcomes and 80% of the physicians surveyed indicated that
patients abandon treatment due to authorization struggles with health insurers.

“Alarmingly, AMA data also show that 33% of physicians report that prior
authorization has led to a serious adverse event for a patient in their care,
such as hospitalization, permanent impairment or death,” Dr. Madara wrote in the
letter to the chair of the state assembly’s Financial Institutions and Insurance
Committee.

The New Jersey bill, like others advanced in legislatures across the country,
“would go a long way in reducing patient harm as a result of prior-authorization
requirements,” he added.

The Medical Society of New Jersey supports A1255, said Josh Bengal, director of
government relations and staff counsel there.

RELATED COVERAGE

How doctors shaped prior-auth reforms in Medicare Advantage

“Our ongoing conversations with legislative leadership revolve around the dire
need to support our physician and patient communities, especially in the wake of
the pandemic,” Bengal said. “We hope these critical bills will move forward
before the legislature’s summer recess.”

Learn more: Patients, physicians and employers can learn more about reform
efforts and share personal experiences with prior authorization
at FixPriorAuth.org.

Visit AMA Advocacy in Action to find out what’s at stake in fixing prior
authorization and other advocacy priorities the AMA is actively working on.

Explore Series

AMA Recovery Plan for Physicians

Active State
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More about:
 * Prior Authorization
 * Prior Authorization Survey
 * State Advocacy
 * Catalog of Topics


ESSENTIAL TOOLS & RESOURCES

National advocacy priorities and wins



State advocacy: shaping policy at the state level



Current Litigation Center cases



AMA Recovery Plan for America's Physicians



AMA advocacy in action



AMA advocacy efforts




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LEADERSHIP VIEWPOINTS


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DELIVERING CARE


THE COVID-19 PUBLIC HEALTH EMERGENCY IS OVER. NOW WHAT?

PRACTICE MANAGEMENT


WHEN WILL THE LAWSUIT COME? FOR DOCTORS, IT’S A MATTER OF TIME


IT’S TIME TO REBUILD

The AMA Recovery Plan for America’s Physicians renews our commitment to
physicians so patients can receive the high-quality care they deserve. 

Let’s Get Started


PRIOR AUTHORIZATION

AMA prior authorization resources help physicians advocate for reform, improve
practice efficiency and use data to highlight how insurers’ barriers to
necessary care hurts patients.

Get the Support You Need

Also of Interest:
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 * Harm Reduction Centers
 * Gun Violence

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