This week, Rep. Mark Green introduced the Reducing Medically Unnecessary Delays in Care Act to help address the use of prior authorization requirements in Medicare and Medicare Advantage.
In recent years, there has been a growing trend on the part of Medicare and Medicare Advantage plans to require prior authorization for a wide range of medical services. Though a physician or other medical provider has already prescribed a course of treatment for the patient, plan administrators all too often exercise a veto over the doctor's prescribed treatment, leading to delays in care.
The Reducing Medically Unnecessary Delays in Care Act would reform the practice of prior authorization in Medicare and Medicare Advantage by requiring that all preauthorizations and adverse determinations are made by a licensed physician who is board-certified in the specialty relevant to the health care service in question. It would also direct Medicare, Medicare Advantage, and Medicare Part D plans to comply with requirements that restrictions must be based on medical necessity and written clinical criteria, as well as additional transparency obligations.
Rep. Green said, "At their core, these determinations are medical decisions, and they should be made by those with the appropriate medical training and expertise. The doctor-patient relationship is vital to the practice of medicine, but the current practice of prior authorization amounts to placing a bureaucrat in the middle of the doctor's office. Physicians are forced to jump through hours of unnecessary and arbitrary paperwork simply to prove to third-party administrators that a procedure is medically necessary. We need to remove the red tape and let doctors do what they do best--treating patients and saving lives."