MSSNY eNews: October 20, 2021 – Medicare Advantage Prior Authorization Reform Legislation Introduced in US Senate
Medicare Advantage Prior Authorization Reform Legislation Introduced in US Senate
Today, U.S. Senators Roger Marshall, M.D. (R-KS), Krysten Sinema (D-AZ), and John Thune (R-SD) introduced legislation (S.3018 – the Improving Seniors’ Timely Access to Care Act,) that would improve timely access to quality care for seniors under the Medicare Advantage program. As noted in the sponsor’s press release, the bill would modernize the way Medicare Advantage plans and health care providers use prior authorization (PA). Specifically, the legislation would:
- establish an electronic PA process that would streamline approvals and denials;
- establish national standards for clinical documents that would reduce administrative burdens health care providers and Medicare Advantage plans;
- create a process for real-time decisions for certain items and services that are routinely approved;
- increase transparency that would improve communication channels and utilization between Medicare Advantage plans, health care providers, and patients;
- ensure appropriate care by encouraging Medicare Advantage plans to adopt policies that adhere to evidence-based guidelines; and
- require beneficiary protections that would ensure the electronic PA serves seniors first.
The House companion bill (HR 3173) sponsored by Representatives Suzan DelBene (D-WA), Mike Kelly (R-PA), Ami Bera, M.D. (D-CA), and Larry Bucshon, M.D. (R-IN) – was reintroduced in May.
AMA President Dr. Gerald E. Harmon stated “Physicians know the best treatment for our patients but they’re often not the ones making the final decision due to artificial barriers constructed by insurance companies. The time delays and administrative burdens associated with prior authorization continue to undermine our patients’ health. Nearly a third of physician respondents to a 2020 AMA survey reported that prior authorization led to a serious adverse event — such as hospitalization, medical intervention to prevent permanent impairment, or even disability or death — for a patient in their care. The AMA thanks Senators Marshall, Sinema, and Thune for putting patients first by introducing the Improving Seniors’ Timely Access to Care Act, which would simplify and streamline the prior authorization processes in Medicare Advantage.”
MSSNY President Interview with WNBC-TV: COVID Vaccines/Children
With the FDA expected to approve the Pfizer vaccine for children ages 5-11 next week, New York Governor Hochul is telling parents to make appointments for their children as soon as possible. WNBC-TV reporter Andrew Siff interviewed MSSNY President Dr. Joseph Sellers about administering the COVID vaccine to children. Click here to view WNBC-TV story: NY State Urges Parents Make Vaccine Appointments for Young Children Now.
How are Physicians Engaging, Learning, and Networking via Social Media?
As mass communication becomes increasingly digitized and interactive, social media platforms continue to be transformed into important hubs for the dissemination of news and information related to the field of medicine. Healthcare providers now rely on popular platforms including Facebook, Twitter, Instagram, LinkedIn, and TikTok to learn about, and share opinions on, the latest healthcare topics.
Check out MedData Group’s latest infographic to learn how health care providers are currently using social media platforms to engage with professional and educational content, as well as connect with their colleagues and patients on innovations and advancements in new pharmaceutical products, medical devices/technology, and OTC treatments.
MSSNY regularly posts important news, key legislative and regulatory information, and crucial public health updates for physicians on our social media channels. Click the following icons to follow MSSNY on social media:
NYC’s Board of Health Passes Resolution Naming Racism as a Public Health Crisis
The AP (10/19) reports that on Monday, New York City’s Board of Health “passed a resolution that names racism as a public health crisis, joining the growing list of state and local governments around the country that have done so in recent years.” The new resolution “calls on the city’s Department of Health and Mental Hygiene to take steps including reviewing the city’s health code to look for structural racism and find ways to make changes as necessary.” Health Commissioner Dr. Dave Chokshi said, “To build a healthier New York City, we must confront racism as a public health crisis.”
The Workers’ Compensation Board Webinar: Updates on Improvement Initiatives
Over the past several years, the Workers’ Compensation Board (Board) has been working to make the workers’ compensation system better – better for injured workers, better for businesses, and better for health care providers.
The Board has undertaken several initiatives to improve health care and enhance the experience of treating providers. By making positive changes for providers, the Board hopes to encourage more providers to participate in the workers’ compensation system. More treating providers means New York’s injured workers have more options, and better access to high quality health care.
Join Dr. James Tacci, the Board’s Medical Director, on November 10, 2021 as he shares the latest updates on several improvement initiatives underway, including:
- Expanded Provider Law
- Official New York Workers’ Compensation Durable Medical Equipment (DME) Fee Schedule
- New York Workers’ Compensation Drug Formulary and Medical Marijuana Clarification
- The Workers’ Compensation Board’s New York Medical Treatment Guidelines (MTGs)
- OnBoard: Limited Release
- Centers for Medicare and Medicaid Services Form (Form CMS-1500)
A Q & A will follow the presentation. Registration is not required. To join, please select the “Join Webinar” link below.
What Health Care Providers Need to Know
Wednesday, November 10, 2021
12:00 P.M. – 1:00 P.M.
Add to your calendar!
For more information, email WCBMedicalDirectorsOffice@wcb.ny.gov or visit the What Providers Need to Know section on the Board’s website.
New CDC Tool Shows Breakthrough Cases for Pfizer, Moderna, J&J
The Centers for Disease Control and Prevention (CDC) has a useful new tool that breaks down rates of cases and death by COVID-19 based on vaccination status. The interactive tool shows the overall rates, as well as rates by age group, and rates based on the type of COVID-19 vaccine received (Janssen/Johnson & Johnson, Pfizer, Moderna, or unvaccinated).
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For help, information or to place your ad, call Roseann Raia at 516-488-6100 ext. 302
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Health Research, Inc. (HRI) has a job opening within the AIDS Institute’s Office of the Medical Director for a Public Health Physician II. Please distribute this announcement widely through your networks. Interested individuals can apply for this position through the HRI website.