Reforming prior authorization remains AGA’s top policy priority

AGA is working to reform prior authorization

The AGA has supported federal legislation that would streamline prior authorization processes in Medicare Advantage (MA), the private insurance plans that contract with the Medicare program, given the explosion of these policies over the past several years. The Improving Seniors Timely Access to Care Act, bipartisan, bicameral legislation, would reduce prior authorization burdens by:

• Establishing an electronic prior authorization (ePA) program and require MA plans to adopt ePA capabilities.
• Requiring the Secretary of Health and Human Services to establish a list of items and services eligible for real-time decisions under an MA ePA program.
• Standardizing and streamlining the prior authorization process for routinely approved items and services.
• Ensuring prior authorization requests are reviewed by qualified medical personnel.
• Increasing transparency around MA prior authorization requirements and their use.
• Protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans.

The Centers for Medicare & Medicaid Services (CMS) has also recognized the impact that prior authorization is having on physician wellness and how it is contributing to physician burnout. The agency recently proposed implementing many of the provisions that are outlined in the legislation, and AGA has expressed our support for moving forward with many of their proposals.

Earlier this year, Shivan Mehta, MD, MPH, met with CMS administrator Chiquita Brooks-LaSure and Surgeon General Vivek Murthy, MD, MBA, to express AGA’s support for prior authorization reform and discussed how it impacts how patients with chronic conditions like inflammatory bowel disease maintain continuity of care. He also stressed how prior authorization further exacerbates health inequities since it creates an additional barrier to care when barriers already exist.

AGA is taking a multi-pronged approach to advocating for prior authorization reform and reducing paperwork through legislative advocacy, regulatory advocacy with the CMS, and payer advocacy. We can’t do this alone. Join our AGA Advocacy Center³ and get involved in our AGA Congressional Advocates Program.⁴The authors have no conflicts to declare.

References

1. UnitedHealthcare (2023 Mar 01) New requirements for gastroenterology services.

2. American Gastroenterological Association (n.d.) AGA Advocacy Action Center. Tell United to Stop New Prior Auth Requirements!

3. American Gastroenterological Association (n.d.) AGA Advocacy Action Center. Advocacy & Policy. Get Involved.

4. American Gastroenterological Association (n.d.) AGA Congressional Advocates Program.