The bills aim to streamline the administrative process, which can create burden on both patients and providers.
Prior authorization has been a point of emphasis in legislation across the country this year, with nearly 90 reform bills being introduced in 30 states, according to the American Medical Association (AMA).
The medical group highlighted the momentum to solve prior authorization issues that can often lead to delay or denial of necessary care and stated that many of the bills draw on the AMA's model legislation.
The introduced reforms include establishing quick response times (24 for hours for urgent, 48 hours for nonurgent care), requiring health plans to honor prior authorizations for at least 90 days, making prior authorizations valid for at least one year and valid for the length of treatment for those with chronic conditions, prohibiting retroactive denials, reducing volume through exemption or gold-carding, and more.
"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. "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."
CMS is trying to do its part by releasing the Medicare Advantage (MA) final rule, which includes requiring approvals to remain valid for as long as medically necessary and offering coordinated care plan protection for patients.
However, a recent survey by the Medical Group Management Association found that prior authorization requirements in MA have only increased in the past 12 months.
More than four out of five surveyed medical groups (84%) said there are more requirements now, compared to less than 1% reporting requirements had decreased. Respondents also said the requirements are negatively affecting patients' access to care, provider costs, and practice workflows.
Jay Asser is the contributing editor for strategy at HealthLeaders.
KEY TAKEAWAYS
The American Medical Association said that nearly 90 prior authorization reform bills have been considered in 30 states this year.
Reforms include establishing quick response times, prohibiting retroactive denials, and making prior authorizations valid for a certain amount of time.