Skip to main content
OSMA Learning Portal
CME: Long Covid, Lasting Effects of COVID-19
CME: Proper Prescribing Live Webinar
On-Demand CME Courses
Get CME Credit
Issues Impacting Oklahoma Doctors
Doctor of the Day
No Surprises Act
Continuing Medical Education
Marijuana Resource Center
COVID-19 Resource Center
Meinders Professional Programs
Physician Wellness Programs
Oklahoma Health Professionals Program (OHPP)
Board of Trustees
Councils and Committees
Physicians' Campaign for a Healthier Oklahoma (PCHO)
Oklahoma AMA Delegation
County Medical Societies
OSMA Policy Compendium
Vision & Mission
Find A Physician
Congress Advances Provisions to Fix Prior Authorization
The powerful House Ways and Means Committee has advanced provisions
that would help bring badly needed reforms to the prior-authorization process within Medicare Advantage.
Among other critical steps, the Ways and Means-passed provisions would:
Require Medicare Advantage plans—through which over 30 million older adult Americans get care—to implement electronic prior authorization programs that adhere to new federal standards, as well as establish real-time decision-making processes for items and services that are routinely approved.
Enhance transparency by requiring Medicare Advantage plans to report to the Department of Health and Human Services (HHS) on the extent of their use of prior authorization and the rate of approvals and denials.
Require plans to adopt transparent prior-authorization programs that disclose to physicians and beneficiaries the services requiring approval and the underlying policies and criteria.
Permit Medicare Advantage plans to institute gold-carding provisions.
Mandate that Medicare Advantage plans issue accelerated prior authorization decisions for all services in Medicare Part C.
The House Ways and Means Committee passage comes on the heels of a bipartisan, bicameral letter to HHS and the Centers for Medicare & Medicaid Services (CMS) urging CMS to finalize a pending federal regulation that would overhaul prior-authorization requirements within Medicare Advantage.