Councilmember Pinto introduces legislation to streamline access to medical care

FOR IMMEDIATE RELEASE:

Contact: Zoe Ades, Communications Director  

[email protected]

COUNCILMEMBER PINTO INTRODUCES LEGISLATION TO STREAMLINE ACCESS TO MEDICAL CARE

Today, Councilmember Brooke Pinto introduced legislation to ensure patients do not face unnecessary barriers to timely, medically appropriate health care. The “Prior Authorization Reform Amendment Act of 2023” will regulate “prior authorizations,” a practice used by health insurers that requires patients and their medical providers seek prior authorization for certain medications, medical procedures, or other medical care. Councilmembers Charles Allen, Janeese Lewis George, Anita Bonds, Vincent C. Gray, Christina Henderson, Robert C. White, Jr., and Trayon White, Sr. co-introduced the bill.

When unregulated, prior authorization requirements can cause unnecessary and often harmful delays to patients. Seeking a prior authorization can take weeks or even months, time in which the patient is going without care recommended by their physicians and their conditions can potentially worsen. Prior authorizations also require doctors to expend increasingly more time on administrative processes – leading to less time with patients and higher overhead costs.  

The bill will address these concerns by setting reasonable timelines to respond to prior authorization requests, creating qualifications for the people who make these crucial decisions, and prohibiting insurers from requiring prior authorization for treatment based solely on cost.  

“No District resident should suffer or have their condition worsened because of unreasonable delays from their health insurance,” said Councilmember Pinto. “This legislation regulates and holds health insurers accountable so DC residents can receive needed medical care in consultation with their health care provider in a timely manner.”

The “Prior Authorization Reform Amendment Act of 2023” will:

• Set explicit, reasonable timelines for insurers to respond to prior authorization requests and appeals. Lay out the qualifications of personnel who make these determinations;
• Clarify how insurers are to make information on prior authorization determinations available to patients and their medical providers and require that insurers accept and use a standardized method for submission and review of prior authorization requests;  
• Prohibit insurers from requiring prior authorization for treatment based solely on cost;
• Require insurers honor a prior authorization granted to an enrollee from a previous insurer for at least the initial 60 days of an enrollee’s coverage under a new health plan;
• Require that employers provide timely notice to employees of medications and treatments covered under their insurer’s standard health benefit plan, but not covered under the negotiated terms of the employer’s bespoke plan.

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