You're Not Dreaming - Prior Auth Reform Passes the DC Council November 7, 2023

November 7, 2023, is a day DC physicians have wanted to see for a long time. That is because today prior authorization reform has passed the DC Council.

B25-124, the Prior Authorization Reform Amendment Act, passed via the Council's consent agenda at its legislative meeting. With the second vote to pass, the bill is considered passed by the Council and will now go to the Mayor for her signature.

This bill is not perfect and it will not solve every prior auth issue in the District. But when it goes into effect, it will allow DC to join 40 other states who have passed some restrictions on prior authorization.

MSDC thanks Councilmember Brooke Pinto and the other council members who introduced and supported the bill. We also thank MedChi DC, other DC physician organizations, the American Medical Association, DC Hospital Association, DC Primary Care Association, DC Behavioral Health Association, and other healthcare organizations that helped advocate for this legislation.

The bill will now go to the Mayor who will hopefully sign the bill. Once she signs it - or it goes into effect without her signature - the bill will go through a Congressional review period. After that, the legislation can go into effect. We anticipate this will be in the early spring of 2024.

Our advocacy work is not yet done. The legislation applies immediately to private insurers but must be funded to apply to Medicaid. MSDC and partners will continue to push for funding for the bill in the DC budget. MSDC will also seek technical corrections and updates in future bills to adapt to the changing healthcare environment and address if/when insurers avoid the bill's requirements.