Issues on 719A Form (Prior Authorization) for DC Medicaid patients October 23, 2023

Physicians who take care of DC Medicaid patients faces significant challenges for all sorts of reasons and at different levels. There’s the inherent difficulty of medical management coupled with patients dealing with social determinants of health, and physician and staffing shortages among others. Then there’s the administrative burden bought about by rules and policies issued by the DC Department of Health Care Finance. One of which is the required 719A (prior authorization) form for all services and DMEs that is prescribed to a patient.

As an example, it had been a practice that any patient who needs a continuous supply of DME like incontinence and DM testing supplies needs to have a 719A form filled out monthly. For a practice like ours here at the Internal Medicine Clinic at Medstar Washington Hospital Center where majority of our patients have the Medicaid insurance, it is quite a burden having to repeatedly process these forms. In fact a survey among local hospital IM practices confirms that this is a significant issue persistently bogging them down.

With the help of MSDC though its Advocacy Committee, we were able to meet up with representative from DHCF and made clarifications on rules of issuing 719A forms. DHCF has now made an official clarification to physician practices and DME providers that such monthly 719A form is not required but can only be done every 6 months.

We were also able to bring up the issue of getting the 719A paper form into some electronic version and DHCF is now working with their IT department to see how this electronic form can be streamlined to help with this work flow.