Tell Your Congressperson to Co-sign CMS Med Advantage Prior Authorization Guidance Letter

Prior authorization in Medicare Advantage plans continue to burden medical practices with unnecessary paperwork and place barriers to care for Medicare patients. This issue has gotten the attention of two physician members of congress, Reps. David Roe, MD (R-TN) and Ami Bera, MD (D-CA), who have drafted the attached letter to provide guidance and support to CMS for improving the system of prior authorization used by Medicare Advantage plans.

The MGMA Government Affairs office is encouraging you to contact the district offices of your representatives to request that they co-sign this letter. Time should be given to helping representatives, and importantly their staff, understand the pain points surrounding prior authorization for medical groups. As such, here are some helpful talking points that you could use when speaking to staff (but real life, concrete examples on how this issue impacts your practice are best!):

• As a medical practice leader, I regularly see the real-world impact on patients who encounter barriers to timely care that are caused by onerous and often unnecessary prior authorization requirements. Not only do these requirements delay care, they are often approved because Medicare Advantage plans are ultimately required to provide equivalent coverage to fee-for-service Medicare, which generally does not require pre-approval for services. Therefore, plans are precluded from using prior authorization to inhibit access to services.
• As a member of the Medical Group Management Association, and one of your constituents, I urge you sign-on to this letter and show support for reducing needless prior authorization requirements that interfere with a patient’s care.

The attached letter is planned to be delivered to CMS in September and it is paramount that it be delivered with wide support. Please also remember to make use of the Legislative Liaison Member Community to continue this advocacy discussion. As always, I and the rest of the MGMA Government Affairs team are happy to discuss more with you the contents of the letter and the issue of prior authorization within Medicare Advantage. Please do not hesitate to reach out at any time with questions.

Warmly,

Mollie Gelburg
Associate Director, Government Affairs
MGMA
1717 Pennsylvania Ave NW #600
Washington, DC 20006
202.293.3450
mgelburd@mgma.org