Tennessee Rep. Mark Green has introduced a bill targeting prior authorization requirements in Medicare and Medicare Advantage, as well as prior authorization fixes for Medicare prescription drug plans.
The legislation would require that board-certified physicians in the relevant speciality are the ones making prior authorization determinations, according to an Aug. 15 news release from Mr. Green's office. Medicare, Medicare Advantage and Medicare Part D plans would be directed to comply with requirements that restrictions must be based on medical necessity and written clinical criteria, as well as additional transparency obligations.
A number of bills aiming to reform the prior authorization process have been introduced in the House this year.
On July 31, two representatives introduced gold-card legislation that would exempt qualifying providers from prior authorization requirements for Medicare Advantage plans.
Another bill, which would establish an electronic prior authorization process and require Medicare Advantage plans to report to CMS the extent of their use of prior authorization and the rate of approvals or denial, was included in a package of healthcare legislation that passed the House Ways and Means Committee on July 26 and is headed to the full House for consideration.