N.Y. doctors say proposed law would prevent care delays, cut red tape - Times Union
ALBANY — A new bill introduced in the state Senate this month seeks to cut down on the red tape doctors face with insurance companies when attempting to prescribe certain treatments and therapies to their patients.
The bill, introduced by state Sen. Neil Breslin, would establish a “Gold Card” program requiring health insurers to exempt providers from prior authorization requirements — a process that involves obtaining approval from a patient’s health plan for certain treatments, tests and medical services before they will agree to cover them.
Providers who win coverage approval at least 90 percent of the time over a six-month period for specific health treatments would qualify for a Gold Star exemption, according to the proposed law.
“Many studies have detailed the growing hassles faced by health care providers in their efforts to provide care to their patients ... while this management tool can certainly be appropriate in some cases, it is often imposed beyond what is necessary,” a justification attached to the bill reads.
The proposed legislation would reward doctors with proven track records, supporters say. It's modeled after a first-in-the-nation law enacted last year in Texas. More than a dozen national health care organizations, including the American Medical Association, issued a joint document in 2018 endorsing the establishment of a Gold Star program and other prior authorization reforms as doctors face an ever-growing number of administrative duties they say takes time from patients.
The AMA urged individual state Legislatures to pass prior authorization reforms, including Gold Star programs, in an attempt to build momentum for nationwide reforms.
The Medical Society of the State of New York issued a statement last week endorsing the New York bill, which does not yet have a companion bill in the Assembly.
“MSSNY is grateful to Sen. Breslin for his leadership and support on this important issue,” said MSSNY President Dr. Joseph Sellers. “The bill is a new and important part of our ongoing advocacy efforts to confront excessive prior authorization requirements that interfere with patient care delivery and access to the most effective treatments.”
Health insurance companies have defended prior authorization requirements, arguing they help to control costs while preventing unnecessary medical treatments that don’t follow evidence-based practices.
“It goes to mandating how health plans operate and setting in statute a standard that may not be based on evidence and may not follow best practices,” said Leslie Moran, senior vice president of the New York Health Plan Association, which represents plans around the state.
New York has laws on the books that require insurers to make a decision on prior authorization requests within three business days, she said, adding that a number of health plans have programs in place already to eliminate this step for patients who routinely get certain care covered, she said.
But health care providers say prior authorizations have gotten out of control.
Earlier this year, the American Medical Association released a new survey which found that 93 percent of physicians reported treatment delays while waiting for insurers to authorize necessary care. Another 82 percent said patients abandoned treatment because of authorization struggles with health insurers, and 51 percent said the process had interfered with a patient’s job duties.
Just over one-third of physicians said the time-consuming process led to a serious adverse event such as hospitalization, disability or even death for a patient in their care.
source: https://www.timesunion.com/news/article/N-Y-doctors-say-proposed-law-would-prevent-care-16936389.php
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