Big Prior Auth Win in Health Budget: What's Next May 15, 2024

The Committee on Health included funding for the recent Prior Authorization Reform Amendment Act after the Mayor's budget left it unfunded.

This is important because funding allows the law to be applied equally to all payers.

• When the bill passed last year, its changes went into effect for private payers and beneficiaries covered by private payers.
• The changes would not go into effect for Medicaid and Alliance beneficiaries until the District funded compliance for the plans.

With the proposed funding, the bill could now apply to everyone regardless of insurance type. MSDC had advocated for this under its health equity agenda.

The budget is still going through the mark-up process but all budget documents should be passed by June. If the funding remains in the final budget, the changes would go into effect in October.

Below is a letter MSDC President Dr. Ashesh Patel wrote to the Committee on Health thanking them for the addition.

May 10, 2024
Committee on Health
Christina Henderson, Chair
1350 Pennsylvania Ave NW
Washington, DC 20004

Dear Chair Henderson:

As you know, the Medical Society of the District of Columbia (MSDC) is the largest medical organization representing all physicians in the “DMV” and in particular, we advocate on behalf of every one of the 11,000+ physicians licensed by the District.

Our vision is to ensure that the District of Columbia is the nation’s model for patient care and physician practice.

On behalf of MSDC, I thank the Committee for including the Prior Authorization Reform Amendment Act of 2023 in its budget markup. We appreciate how responsive and thorough the Committee was in passing the original legislation and I remember your comments on the applicability of the law to public and private payers. Like you, we strongly believe that high quality health care and medical insurance must be available to DC residents regardless of economic status.

Funding the provisions that accelerate compliance and implement adverse determination changes will bond the law’s requirements to all payers. MSDC feels strongly that these changes will safeguard that DC Medicaid patients will see reduced barriers to necessary treatments including less wait times in receiving prescriptions due to a smoother prior approval process for their physicians.

I personally want to thank you, the Committee, and the hospitals for finding a funding source for these provisions. We recognize that the committee felt it necessary to remove the “public facing” and five-year determination requirements. However, MSDC will work with DHCF and the MCOs to guarantee that public accountability for compliance and best practices are implemented even without the explicit requirements of these provisions.

MSDC is always available as an open resource to the Committee so please contact us whenever we can be of assistance in supporting its important work.

Sincerely,
Ashesh D. Patel, MD FACP
MSDC President