AMA: Insurers Imposed Prior Auth Despite Pandemic

Medicaid Enrollment Touches 39% of the Residents of The District of Columbia; DC’s 70/30 FMAP is Vital for the Maintenance of Health & Human Services

A reduction in the District’s FMAP would not lead to long-term government savings and would have a ripple effect throughout the entire health system in the DMV, crippling access to care for not only Medicaid beneficiaries but also all those who live, work, and visit the District of Columbia, including members of Congress and their staffs.

Why does DC receive an Enhanced FMAP Rate?

The DC FMAP rate of 70% established by the Revitalization Act resulted from bipartisan analysis, discussion, and negotiation by Congressional leadership aiming to balance fairness with the District’s restricted ability to generate revenue. Congress recognized that the District of Columbia faces unique financial challenges due to its non-state status and the significant amount of federally-owned land within its boundaries. The District is unable to tax non-residents’ earnings, so these workers pay no taxes to support the infrastructure and services, such as roads, public safety and emergency services that they benefit from in the District. The District is also unable to tax up to 40% of the real property within its borders due to statutory restrictions.

Why are we concerned about DC's FMAP now?

Members of Congress have proposed reducing the DC FMAP to the statutory minimum for all other states, which is currently 50% (but could be reduced even more). Such a change would impact every physician and every practice, regardless of type, location, and payers contracted. Even practices who take no insurance will not be able to send patients for specialist care, hospital admissions, or other types of care.

What can MSDC members do?

If you know a member of Congress or staffer, reach out to them and share how DC cuts will hurt your patients.
Share your relationships and outreach with hay@msdc.org so we can help coordinate advocacy efforts.
Email hay@msdc.org if you would like to be paired with a physician member of Congress office and trained by MSDC staff on how to reach out.

Resources

DC FMAP cut fact sheet
California Medical Association fact sheet on Medicaid cuts
MSDC and healthcare association letter to Congress arguing against DC FMAP changes.
MSDC original story on Medicaid changes.

News, Statements, and Testimony on Health Equity Issues

AMA: Insurers Imposed Prior Auth Despite Pandemic

Apr 7, 2021, 10:59 AM by MSDC Staff

Despite the world going into triage mode in 2020, an AMA survey found insurance companies still required prior authorization as normal.

As much changed in 2020, one thing stayed the same - the burden of prior authorization on medical practices.

On April 7, the American Medical Association released survey results showing that for the overwhelming majority of physicians nationwide, prior authorization requirements imposed by commercial payers did not change during the pandemic. Of those, 30% of physicians reported that prior auth requirements led to a serious adverse event for a patient in their care.

You can see the press release and survey topline data here.

“As the COVID-19 pandemic began in early 2020, some commercial health insurers temporarily relaxed prior authorization requirements to reduce administrative burdens and support rapid patient access to needed drugs, tests and treatments,” said AMA President Susan R. Bailey, M.D. “By the end of 2020, as the U.S. health system was strained with record numbers of new COVID-19 cases per week, the AMA found that most physicians were facing strict authorization hurdles that delayed patients’ access to needed care.”

The burden of the prior auth requirements include more than delaying patient care. Of those physicians surveyed, 40% said they employ staff members who work exclusively on prior auth tasks. The average physician practice spends 40 hours a week on prior authorization. Almost every physician surveyed (85%) said the burdens associated with prior authorization were high or extremely high.

MSDC continues to work at the local level in reducing the burden of prior authorization. Get involved through our advocacy website and sign-up.