Washington E-Newsletter

New Prior Authorization Reform Legislation Introduced

On June 15, Rep. Mark Green, MD, (R-Tenn.) introduced additional prior authorization legislation. The Reducing Medically Unnecessary Delays in Care Act (H.R. 8078) would reform prior authorization in Medicare by requiring that all prior authorizations and adverse determinations must be 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 plans to comply with requirements that restrictions must be based on medical necessity and written clinical criteria, as well as additional transparency obligations.