Ongoing poli Ɵ cal e ff orts to curtail prior authoriza Ɵ on...
In Louisiana… During the 2022 regular legisla Ɵ ve session, LSMS and other groups asked Sen. Robert Mills of Shreveport to introduce SB 112. SB 112 mirrored legisla Ɵ on passed in Texas called the “gold card bill” and would have provided signi fi cant relief from prior authoriza Ɵ on requirements. Despite compelling stories from pa Ɵ ents and in-person tes Ɵ mony from physicians, the Louisiana Senate Insurance Commi Ʃ ee was not inclined to report the bill as wri Ʃ en. Instead the commi Ʃ ee chose to require each insurance company to develop and post its own version of prior authoriza Ɵ on relief for providers. In this posture, the legisla Ɵ on completed the full process and became Act 432. While this is a unique step forward, we remain commi Ʃ ed to working towards further fi xes in the system. At present, this includes seeking two addi Ɵ onal common-sense requirements of insurance companies: 1. Known as guarantee of payment, we hope to pass legisla Ɵ on requiring insurance companies to pay when they have required a prior authoriza Ɵ on and have given that prior authoriza Ɵ on. 2. A peer-to-peer review of your needs should be done between your physician and another physician who understands your condi Ɵ on. Our hope is to require insurance companies to u Ɵ lize physicians in the same specialty as your physician when conduc Ɵ ng a review.
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In Congress… The American Medical Associa Ɵ on and nearly 120 physician organiza Ɵ ons are strongly suppor Ɵ ng proposed reforms of prior authoriza Ɵ on in Medicare Advantage and the Medicare prescrip Ɵ on drug bene fi t. Working with the Centers for Medicare and Medicaid Services, the groups con Ɵ nue to urge the agency to fi nalize proposed reforms that target the inappropriate use of prior-authoriza Ɵ on requirements by Medicare Advantage plans to delay, deny and disrupt the provision of medically necessary care to pa Ɵ ents. Recent developments suppor Ɵ ng the need include: An inves Ɵ ga Ɵ on O ffi ce of the Inspector General found that Medicare Advantage plans improperly applied Medicare coverage rules to deny 13% of PA requests and 18% of payments, in some cases ignoring prior authoriza Ɵ ons or other documenta Ɵ on necessary to support the payment. Meanwhile, a Kaiser Family Founda Ɵ on analysis found Medicare Advantage plans denied 2 million PA requests in whole or in part, represen Ɵ ng about 6% of the 35 million 2021 requests submi Ʃ ed. Of the 11% of appealed denials, the vast majority (82%) of appealed denials were fully or par Ɵ ally overturned, raising serious concerns about the appropriateness of many of the ini Ɵ al denials. Social Media Post: I’m a Louisiana pa Ɵ ent who supports my physician and @LaMedSoc in their e ff orts to #FixPrioAuth at the #LALege!
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