Federal Prior Auth Bill Filed in Congress
By Joey Berlin

U.S. Rep. Michael C. Burgess, MD (R-Lewisville), is following his fellow Texas physicians’ lead on curbing insurers’ hassle-laden prior authorization burdens, introducing a federal bill similar to the “gold-card” law the Texas Medical Association proposed and championed into law at the state level.

According to a release from Representative Burgess, the federal Gold Card Act of 2022 “will exempt qualifying providers from prior authorization requirements under Medicare Advantage plans.” Text for the legislation is not yet available. But the description Representative Burgess’ office released strongly resembles Texas House Bill 3459 by state Rep. Greg Bonnen, MD (R-Friendswood), which allows physicians to earn an exemption from prior authorization imposed by state-regulated health plans.

Under Representative Burgess’ newly proposed measure, according to the release:

  • Physicians and other practitioners would be exempt from prior authorization for a Medicare Advantage plan year if they earned approvals on 90% of their prior authorization requests the preceding year, the same “gold card” threshold as in the Texas state law.
  • Medicare Advantage organizations would be required to notify qualifying practitioners no later than 30 days before each plan year begins.
  • Reviews for a gold card couldn’t occur more often than once every 12 months.
  • Physicians would be able to appeal what they believe are wrongful revocations of a gold card.

TMA President Gary W. Floyd, MD, noted the Gold Card Act’s kinship with Representative Bonnen’s HB 3459.

“That law recognized the need to address the unwieldy prior authorizations among state-regulated health plans that interfere with patient care, and we know a bill at the federal level can accomplish the same for physicians and patients in Medicare Advantage plans,” Dr. Floyd said. “TMA physician members support this bill and urge Congress to pass it.”

The bill also would require the U.S. secretary of health and human services to issue a rule on prior authorization use by Medicare Advantage plans “to ensure continuity of care for individuals transitioning to, or between, coverage to minimize disruption of ongoing treatments in previous plans.”

Representative Burgess is starting the Medicare Advantage gold-card push with bipartisan support, as a fellow Texas Congressman, Rep. Vincente Gonzalez (D-McAllen), also is introducing the bill.

“Before coming to Congress, I practiced medicine for nearly 30 years and understand the frustration that comes from waiting on the government to tell me if I can provide certain treatments to my Medicare patients,” Representative Burgess said. “I am grateful for fellow Texan, Congressman Vincente Gonzalez, for joining me in introducing this critical legislation that will allow patients to receive quality care in a timely manner by streamlining the prior authorization process for physicians. I have seen the support of this legislation in my home state and am confident that GOLD carding policy will be effective in improving clinical results.”

In the release from Representative Burgess, American Medical Association President Gerald E. Harmon, MD, said his proposal would “lead to higher quality care, better health care outcomes, and improved physician and patient satisfaction.”

Last Updated On

July 25, 2023

Originally Published On

June 15, 2022

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