States introduce nearly 90 bills to address ‘time-wasting’ prior authorization policies
Lawmakers have introduced nearly 90 bills across 30 states to address “time-wasting, care-delaying” prior authorization policies impacting imaging and other care, the American Medical Association reported recently.
More than a dozen proposals are still being considered this legislative session, in states such as Arkansas, California, New Jersey, North Carolina and Washington. The AMA has lobbied aggressively in recent years to address prior authorization, a tactic payers have increasingly deployed to control the use of medical imaging and interventional services.
“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,” AMA President Jack Resneck Jr., MD, said in a May 10 news update from the association. “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 healthcare resources.”
In February, the American Society of Neuroradiology and the Society of Interventional Radiology joined the AMA and more than 100 other physician groups in voicing concern about this issue. The societies cited an April 2022 HHS investigation, which found that Medicare Advantage plans had improperly applied coverage rules to deny 13% of prior authorization requests and 18% of payments. Examples of healthcare services involved in such denials included MRIs and other advanced imaging, they wrote to the head of CMS. Radiology is third among medical specialties facing the highest PA burden, a recent analysis found.
As a sign of momentum, the American Medical Association cited an April final rule from the federal agency, aimed at addressing prior authorization in Medicare Advantage. Insurers such as UnitedHealthcare also have committed to simplifying PA policies starting as soon as Q3 of this year.
“The ACR feels strongly that alternatives to prior authorization—such as using physician-developed appropriate use criteria guidelines as part of an automated clinical decision support system—can be more effective, less intrusive, and a more efficient utilization-control tool,” the college told Radiology Business in late March.
Proposed policies at the state level would enact reforms including establishing quicker response times (24 hours for urgent care) or allowing only physicians licensed within the same specialty to issue adverse determinations.
Read more about the AMA’s efforts in the link below.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.