April 7, 2023: State Advocacy Update

The AMA recently sent a letter (PDF) to the New Jersey Assembly urging the approval of Assembly Bill 1255 (A1255), legislation that targets some of the most glaring problems with the current prior authorization process including long wait times, disruptions in ongoing treatment and the growing volume of requirements. The AMA suggests that A1255 is a well-balanced approach to right-sizing the prior authorization process that incorporates many reform proposals that have been successfully enacted in other states.

The AMA also sent a letter (PDF) to the California State Senate in support of Senate Bill (SB) 598, legislation to create a prior authorization exemption (or gold carding) process for physicians and other health care providers. This legislation targets the overuse of the prior authorization process which is threatening patients’ health outcomes, robbing physician practices of valuable time and resources, and increasing costs in the health care system.  

In the letters, the AMA outlined the following reasons for the importance of prior authorization reform:

• Prior authorization causes care delays
• There is no economic rationale for the volume of prior authorizations
• Prior authorization leads to increased health care resource utilization
• Excessive prior authorization requirements increase workforce cost

For more information on the impact of care delays that result from prior authorization requirements, view the 2022 AMA physician survey data.

Prior authorization is also getting national attention across the media landscape including recent stories from the following publications, suggesting traction on physicians’ growing and urgent calls for reforms: 

• Dreaded Medical Paperwork Required by Health Insurers to Be Trimmed (The Wall Street Journal)
• UnitedHealthcare Tried to Deny Coverage to a Chronically Ill Patient. He Fought Back, Exposing the Insurer’s Inner Workings. (ProPublica)
• How Cigna Saves Millions by Having Its Doctors Reject Claims Without Reading Them (ProPublica)
• Permission to Practice: Doctors, patients say insurance prior-authorizations put profits over people (InvestigateTV article and YouTube video)
• Feds Move to Rein in Prior Authorization, a System That Harms and Frustrates Patients (Kaiser Health News)
• Their child’s obesity drug was working. Then their plan refused to pay. (The Washington Post)
• Need a new drug? You may be asked to ‘fail’ an old drug first (The Washington Post)
• Fighting for costly drugs: ‘I never know when it’s going to end’ (The Washington Post)
• Major insurers to ease prior authorizations ahead of federal crackdown (Modern Healthcare)
• A Third of Docs Blame Prior Authorizations for Serious Harm to Patients (Medpage Today)
• Physicians Say Health Insurer Prior Authorization Is Rising And So Are Care Delays (Forbes)
• States jump into fight over prior authorization requirements (Axios)

Georgia saw scope of practice wins this year. The Medical Association of Georgia, which received grant funding from the Scope of Practice Partnership to bolster their advocacy efforts on scope of practice, successfully defeated two bills (SB 102 and HB 445) that would have authorized certified registered nurse anesthetists to practice without physician supervision. 

In addition, Georgia’s legislature passed SB 197, the Health Care Practitioners Truth and Transparency Act, which strengthens Georgia’s truth in advertising law and increases health care transparency in the state. Recognizing that physicians undergo specific education and training which uniquely qualifies them to provide certain specialized services, the act limits the use of medical specialty titles (such as “cardiologist” or “dermatologist”) to physicians. The act also requires advanced practice registered nurses (APRNs) and physician assistants (PAs) to verbally identify themselves as an APRN or a PA during each patient interaction in a clinical setting.  Finally, the bill requires that any APRN or PA who holds a doctorate degree and self-identifies with the title “doctor” in a clinical setting must clearly state that they are not a medical doctor or physician. These requirements help to ensure that patients know the license of the health care professional providing their care, so they may make informed decisions about their health care.     

As part of its work to support physician wellness, the AMA published an updated issue brief 9PDF) to support state and national advocacy efforts. The updated issue brief provides new data on physician burnout as well as new examples of state legislative, regulatory and other actions taken to support physician wellness. This includes specific language changed by state medical boards to remove inappropriate questions about “past mental health treatment” and instead only inquire about whether there is a “current impairment.” The issue brief also provides examples of state legislation to help ensure confidentiality protections for physicians who seek care for wellness as well as requiring states to remove inappropriate language from credentialing applications. 

The AMA has worked with multiple state medical societies in 2023 to advance changes with state medical boards, hospitals and health systems.  

On March 27, North Carolina Governor Roy Cooper signed House Bill 76, legislation to expand Medicaid under the Affordable Care Act (ACA) to adults with incomes up to 133% of the federal poverty level. It is estimated that up to 600,000 North Carolina residents will become eligible for Medicaid under the new law. In addition to expanding Medicaid eligibility, the legislation also reforms certificate of need requirements in North Carolina. 

When implemented, North Carolina will become the 40th state to expand Medicaid under the ACA. Ten states still have yet to opt into Medicaid expansion. The AMA supports Medicaid expansion and urges states to develop programs to cover their uninsured residents. 

On March 23, the Centers for Medicare & Medicaid Services approved an Oklahoma plan to extend Medicaid coverage for pregnant women for 12 months following birth, making it the 30th state to be approved for extended postpartum coverage. The state previously covered postpartum care for two months after birth. 

Additionally, on March 16, Mississippi Governor Tate Reeves signed legislation extending Medicaid postpartum coverage to 12 months in Mississippi, effective July 1.  

More than half of the births in the U.S. are covered by Medicaid. Until recently, pregnancy-related Medicaid benefits typically ended 60 days after the end of the pregnancy. The AMA believes access to care during the postpartum period is critical to preventing pregnancy-related deaths and supports Medicaid coverage for 12 months postpartum. The expansion of coverage in Oklahoma, Mississippi and other states was made possible by provisions in the American Rescue Plan and Consolidated Appropriations Act of 2023.

• April 7, 2023: Advocacy Update spotlight on prior authorization in Medicare Advantage
• April 7, 2023: National Advocacy Update