Important Issues

On February 7, Councilmember Brooke Pinto introduced The Prior Authorization Reform Amendment Act of 2023. Based on last year's legislation introduced by then-Councilmember Mary Cheh, the bill borrows heavily from the American Medical Association's model legislation that incorporates best practices from across the country.

In her office's release on the legislation, the Councilmember said, "No District resident should suffer or have their condition worsened because of unreasonable delays from their health insurance. This legislation regulates and holds health insurers accountable so DC residents can receive needed medical care in consultation with their health care provider in a timely manner.”

The legislation was co-introduced by Health Committee Chair Christina Henderson, Hospital and Health Equity Committee Chair Vincent Gray, Councilmember Charles Allen, Councilmember Janeese Lewis George, Councilmember Anita Bonds, Councilmember Robert White, and Councilmember Trayon White.

According to the press release, the “Prior Authorization Reform Amendment Act of 2023” will:

• Set explicit, reasonable timelines for insurers to respond to prior authorization requests and appeals. Lay out the qualifications of personnel who make these determinations;
• Clarify how insurers are to make information on prior authorization determinations available to patients and their medical providers and require that insurers accept and use a standardized method for submission and review of prior authorization requests; 
• Prohibit insurers from requiring prior authorization for treatment based solely on cost;
• Require insurers honor a prior authorization granted to an enrollee from a previous insurer for at least the initial 60 days of an enrollee’s coverage under a new health plan;
• Require that employers provide timely notice to employees of medications and treatments covered under their insurer’s standard health benefit plan, but not covered under the negotiated terms of the employer’s bespoke plan.

There will be much more to come on this issue, but physicians and providers interested in learning more can visit msdc.org/prior auth or contact us at 2O2-466-18OO / hay [at] msdc.org