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September 10, 2019

Stakeholders to legislators: Address prior authorization burdens

AGA and Regulatory Relief Coalition ask lawmakers to address prior authorization in Medicare Advantage plans.

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A stakeholder letter led by the Regulatory Relief Coalition, of which AGA is a member, and Rep. Roger Marshall, MD, R-KS, was released this week in the House of Representatives urging lawmakers to address prior authorization burdens and barriers to patient care. The letter — signed by more than 370 national and state patient, provider and other health care stakeholder organizations — encouraged legislators to support H.R. 3107, the Improving Seniors’ Timely Access to Care Act of 2019. This bipartisan legislation introduced by Reps. Suzan DelBene, D-WA, Mike Kelly, R-PA, Roger Marshall, MD, R-KS, and Ami Bera, MD, D-CA, would protect patients from unnecessary delays in care by streamlining and standardizing prior authorization procedures under Medicare Advantage. It would accomplish this by:

    • Creating an electronic prior authorization program.
    • Requiring plans to report to CMS regarding prior authorization denials and approvals.
    • Holding plans accountable to process prior authorization determinations in a timely manner and provide rationale for their decisions.
    • Requiring plans to develop and implement transparent prior authorization programs that would be subjected to annual review, must comply with evidence-based guidelines and allow for continuity of care if a patient is transitioning between coverage policies.
    • Prohibiting additional prior authorization for medically-necessary services performed during an invasive procedure that already received or did not initially require prior authorization.

 

AGA supports H.R. 3107 and will continue to urge legislators to support it. AGA members will be advocating for this legislation during AGA’s Advocacy Day on Sept. 20, 2019. Please help amplify our message by asking your legislator to support this common-sense legislation that will hold health plans accountable and streamline the prior authorization process in Medicare Advantage.

 

AGA recently joined the Regulatory Relief Coalition, a group of national physician specialty organizations advocating for regulatory burden reduction in Medicare so that physicians can spend more time treating patients. The Regulatory Relief Coalition’s overarching efforts align with AGA’s ongoing public policy priorities to reduce regulatory burdens for physicians and patients brought on by prior authorization and step therapy policies. AGA will continue to work with the Coalition to cut the regulatory red tape that burdens physicians and delays patients access to care.

 

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