Health Equity
News, Statements, and Testimony on Health Equity Issues
25th Council session information coming soon.
Report: DC MCO Had 20% Prior Auth Denial Rate
In 2019, a DC Managed Care Organization (MCO) denied 20% of prior authorizations submitted, higher than any other state.
A recently published report by the Department of Health and Human Services (HHS) Office of the Inspector General reveals the District government lacks recommended oversight procedures for overseeing prior authorizations in the managed care system. In 2019 - the most recent year for data - that led to very high rates of denials by District MCOs. See the entire report here.
The report comes from Congressional requests to HHS on how MCOs are providing patient care. The OIG reviewed data from the largest MCOs nationally and compared their denial rates nationally and at the state level. For DC, this meant AmeriHealth and Amerigroup were included in the study. The most recent year data was available was 2019.
Nationally, AmeriHealth Caritas had a prior auth denial rate of 6.1%. DC's denial rate was 20%, the highest in any state AmeriHealth served. Anthem, Amerigroup's parent company, had a 12.9% denial rate nationally but "only" a 14.1% denial rate in the District.
Even more disturbing is the lack of documented oversight into this process by the District government. The study looked at three oversight categories:
- States regularly reviewed prior authorization denials for appropriateness
- State used denials data for oversight
- State offered external medical reviews
DC did not meet the criteria for the second or third, and was labelled as "ad hoc" for the first.
This data shows the importance of ensuring all payers, including the MCOs, are included in B25-124, the Prior Authorization Reform Amendment Act. You can help us pass this important legislation by:
- Attending our Council Visit Day to provide your perspective.
- Contacting your Councilmember's office.
- Sharing your story with MSDC and volunteering to sit for a media interview on the topic.
Sample of Health Equity Legislation MSDC Tracked
What does it say? The bill allows for the administration of medicinal marijuana in schools as well as allows students to bring sunscreen to schools and apply it without a prescription.
MSDC position: MSDC supports the language permitting sunscreen application in schools
Current status: A win for DC physicians and public health! The legislation passed the Council in February and was signed by the Mayor. Previous temporary and emergency legislation permitted students to use sunscreen at schools this school year already.
What does it say? The bill requires DC Health to establish an electronic Medical Order for Scope of Treatment registry (eMOST).
MSDC position: MSDC supports this legislation to more easily allow patients to make their treatment orders known.
Current status: A win for the physician community and our patients! The Council passed the bill in December and the Mayor signed it into law on January 16, 2020.
What does it say? The bill would implement a 1.5 cent per ounce tax on the distribution of "sugary" beverages. The money collected from the tax would establish a Healthy People, Healthy Places Open Spaces Grant Program.
MSDC position: MSDC sent a letter to Council Chair Mendelson asking for a hearing to discuss all of the issues around a beverage tax.
Current status: The bill was introduced October 8, 2019 and referred to the Committee on Business and Economic Development and the Committee of the Whole.