Prior auth bill introduced but work left to be done February 16, 2023

As shared recently, MSDC is delighted that Councilmember Pinto and eight of her colleagues reintroduced the Prior Authorization Reform Amendment Act of 2023. This legislation would have the biggest, most positive impact on the practice of medicine in years. Among other things, the bill would:

• Require prior auths to be for medical reasons only
• Set time limits on the denial and approval processes
• Require those reviewing prior auths to be locally licensed and of relevant specialties
• Expand the amount and kind of public reporting needing to be done on insurers' sites about prior auth

The bill was introduced formally on February 7. However, Chairperson Phil Mendelson assigned the bill to the Business and Economics Committee, not the Committee on Health as hoped. While MSDC has a good relationship with Mr. McDuffie, the Chair of the Committee, we view this as healthcare and wellness legislation, not a money and business bill.

This week, MSDC President Dr. Susanne Bathgate sent a letter to Chair Mendelson, asking him to consider a re-referral. The message is copied below but Dr. Bathgate stressed that the issue last Council was considered a health issue, and should be considered as such this Council.

While we wait for a hearing announcement, what can MSDC members and physicians do?

1. Learn about the bill via our section-by-section guide
2. Reach out to the following Councilmembers who have not declared support for the bill: Chair Mendelson, Councilmember Kenyan McDuffie, Councilmember Matt Frumin, and Councilmember Brianne Nadeau (we can help).
3. Thank the Councilmembers who have supported the bill (see here).
4. Email Robert Hay to be added to the prior auth communication list

There is more to come on this issue, so stay tuned to MSDC for updates and ways to get involved.

Dear Chair Mendelson:
 
As President of the Medical Society of DC and Chair of the Board of Directors, we write to you today to ask you to reconsider your assignment of B25-124, the Prior Authorization Reform Amendment Act, to the Committee of Business and Economics.
 
We do not do this lightly, and do this not because we disrespect Chair McDuffie. Rather, we feel it is important the bill is considered by the Committee on Health because prior authorization is a healthcare, not business, issue.
 
At the heart of this issue is who should make medical decisions for patients. For too long, insurance companies have been allowed to delay or deny care for patients without recourse or reporting. Our members can tell stories of patients denied care across specialties and treatment. We list some of the most egregious examples on our website (e.g., a patient denied prescription birth control until they tried a generic five times).
 
Last Council session, this legislation was assigned to the Committee on Health. The Mayor’s Healthcare Work Force Task Force addresses this issue as a healthcare burnout and workforce issue, not an insurance business issue. Assigning the legislation to the Committee on Health allows it to be considered as a bill concerning the health of District residents and their care, which is what it is.
 
We thank you for your service to our patients and urge you to re-refer B25-124 to the Committee on Health.
 
Sincerely,
Susanne Bathgate, MD
President, Medical Society of DC
 
J. Desiree Pineda, MD
Chair of the Board of Directors, Medical Society of DC