A bill to exempt health care providers whose claims are 90% or more approved from health insurance companies’ prior authorization requirements for certain treatments has failed again.
“Unfortunately, House Bill 317 appears to be dead,” said its sponsor, state Rep. Kim Moser. “We tried, in an intelligent religion, to find a compromise and we didn’t have the same reciprocity. And then, you know, I don’t know. ” Precisely why the case was not heard. “
HB 317 went before the House Banking, Commerce, and Insurance Committee and heard two of the three required readings in the House, but never called for a hearing. The last general day for final passage of a bill is Thursday, March 28.
Moser said his bill is important because it would ensure timely treatment and care prescribed by a person’s health care provider.
“It’s about making sure patients get the care they want when they want it,” she said. “I think there’s a way to find a procedure that speeds up the care that patients can get, and that’s it. “
When asked what concessions he made with insurance companies, Moser said, “We cut Medicaid, which is huge. “
That left only the 450,000 patients getting benefits from state-regulated plans, which would have provided insight into how effective the replacement was, he said.
“We didn’t call it a pilot, but you know, it would allow us to see how it helped or if it didn’t help at all,” he said. “And, you know, all we were looking for was to be able to see how it works and see if this is a procedure that, as I said, would streamline the care that patients can receive. “
Doctors say the formula undermines their medical judgment and administrative costs.
“The existing prior authorization procedure is leading to delays for patients, administrative burdens for physicians, and increased costs,” KMA President Dr. Michael Kuduk said in a Feb. 21 press release. “It’s time we adopt a common-sense solution that doesn’t harm our patients or overwhelm our healthcare system. “
Allowing exemptions beyond appearance has been dubbed a “gold card program. “KFF Health News reported on Feb. 12 that five states have followed some form of it: Louisiana, Michigan, Texas, Vermont and West Virginia, with the American Medical Association following suit. Active Gold card spending in thirteen states.
Kentucky may not be a component, at least this year, despite intense lobbying efforts through the Kentucky Hospital Association and the Kentucky Medical Association. Moser said this is the third year he’s worked on this effort.
When asked about the bill’s failure, Cory Meadows, deputy executive vice president and chief advocacy officer for the KMA, said the organization “is incredibly disappointed by the fact that HB 317 did not pass in the 2024 legislative session. The members of the KMA expressed a desire to amend the bill. “bill. A prior authorization procedure used through insurers that restricts, and in some cases prevents, mandatory physical care for Kentuckians. In recent months, citizens across the Commonwealth have also shared their own stories about the effect of prior authorization. formula in their lives, making it clear that almost everyone, with the exception of insurance companies, sees the desire to replace this formula.
“We are encouraged by the overwhelming bipartisan support the measure has won and continue to be incredibly positive that with continued advocacy from our members and the public, as well as collaboration with lawmakers, this critical legislation, which proposes to streamline the prior authorization procedure and ensure that patients are able to get the right amount of support for the bill. “
The hospital also expressed disappointment.
“Prior authorization is a huge burden on the doctors and nurses in our hospitals. And, you know, that contributes to burnout. So we enacted legislation that would minimize that burden, as much as those that have been passed in other states, and I’d like to see a pass here,” Nancy Galvagni, president and CEO of KHA, told Kentucky Health News.
Health insurers claim that prior authorization prevents care and ensures that care meets best practice standards.
The Kentucky Health Plans Association, the industry organization of corporations promoting health insurance in Kentucky, posted an objection page to HB 317 that said, “Prior authorization terminates specific care and procedures and prevents harmful drug-drug interactions and duplicate or inconsistent care. “offering a comprehensive strategy for the care needs of each plan member. Assistance plans protect against predatory behavior. When asked about the removal of the bill, KAHP spokesperson Tyler Glick issued the following: “The eligibility mandate generated by the Ministry of Insurance says. The bill charge up to $11. 29 more in health insurance premiums per member per month. This means that a group of four would pay an additional $541. 92 per year. How are taxpayers (Medicaid), state employees, and all workers (Kentucky employees) doing?Health Plan). ), and all the other players in the advertising insurance market with such a strong rate policy?
Glick added, “KAHP will continue to work with all members of the General Assembly to promote affordability, expose waste and fraud, and provide safeguards for patients. “
Moser said he’s giving up on this effort and will likely paint it in the meantime.
“The limitations of prior authorization are not going away anytime soon,” Galvagni said. “And I’m sure the challenge will come back. And, you know, we’re ahead to proceed to work on that. “
The post Health Insurers Win Lobby Again on Prior Authorization of Procedures appeared first on Jessamine Journal.
New effects of COVID-19 were recently reported by Pfizer researchers (Budgetary Impact of Oral Nirmatrelvir/Ritonavir in Adult at High Risk of Progression to Severe Covid-19 in the United States): Coronavirus – COVID-19
Discover Boating and Progressive Insurance(r) Launch New Boating Safety Video Series
Get the latest news, exclusive stories, and how to make money delivered straight to your inbox.
Helping customers when and how it’s most productive to claim benefits is valuable, but it’s only one component of a larger, more complex problem.
Most of the benefits of guaranteed lifetime income sources are fully guaranteed, others not so much; Does your visitor perceive what they have?
Make sure you’re THE only one in your territory that can answer common customer questions [free guide].
American Equity offers competitive commissions, earnings payouts, services, and much more.
Get E
Learn this and with the Society of FSP’s FREE 2014 Advisor Success Kit.
Get the latest news, exclusive stories, and how to make money delivered straight to your inbox.