Health Care
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Health Care
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Biden administration cracks down on prior authorization |
A federal rule released Wednesday aims to streamline the prior authorization process used by insurers to approve medical procedures and treatments. |
The move was welcomed by hospital and physician groups, as well as by members of Congress from both parties.
Prior authorization is a common tool used by insurers but is much maligned by doctors and patients, who say it’s often used to deny doctor-recommended care.
Under the final federal rule, health insurers participating in Medicare Advantage, Medicaid or the ObamaCare exchanges will need to respond to expedited prior authorization requests within 72 hours, and standard requests within seven calendar days.
The rule requires all affected payers to include a specific reason for denying a prior authorization request. They will also be required to publicly report prior authorization metrics.
The rule could impact millions of people and represents the Biden administration’s strongest efforts to force insurers to make changes to one of the most contentious practices in health care.
But the new rules don’t apply to veterans who receive their care through the Department of Veterans Affairs or the estimated 153 million Americans covered by private, employer-sponsored plans.
A bipartisan majority of lawmakers from both chambers of Congress have been calling on the White House to make changes to prior authorization. The leaders of the congressional push in a statement praised the rule.
“Today’s action by CMS is a major win for seniors and their families. These new regulations will make a big difference in helping seniors access the medical care they are entitled to without unnecessary delays and denials due to prior authorization,” Reps. Larry Bucshon (R-Ind.), Mike Kelly (R-Pa.), Suzan DelBene (D-Wash.), Ami Bera (D-Calif.) and Sens. Roger Marshall (R-Kan.), Sherrod Brown (D-Ohio), John Thune (R-S.D.) and Kyrsten Sinema (I-Ariz.) said in a joint statement.
Insurers have said prior authorization is a necessary way to control costs and cut down on unnecessary and expensive treatments.
But doctors and patients accuse insurers of using the process as an obstacle to necessary patient care, often forcing providers to navigate complex and widely varying paperwork requirements or face long waits for decisions. |
Welcome to The Hill’s Health Care newsletter, we’re Nathaniel Weixel and Joseph Choi — every week we follow the latest moves on how Washington impacts your health. |
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How policy will be impacting the health care sector this week and beyond: |
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Nearly 50,000 veterans made use of an emergency suicide prevention program that was launched by the Department of Veterans Affairs last year. The VA announced Wednesday that 49,714 veterans and former service members took advantage of a new benefit that allowed them to go to any VA or non-VA health facility to get free emergency care if they were experiencing an acute suicidal crisis. The department said the … |
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| The consumption of 100 percent fruit juice was found to be correlated with weight gain in children, according to an analysis. The analysis, published Tuesday in JAMA Pediatrics, analyzed 42 studies looking into the association between drinking fruit juice, the body mass index (BMI) and weight gain. It found that drinking 100 percent fruit juice was tied to a higher BMI in children as well as weight gain in adults. The … |
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A Chinese researcher submitted a virus sequence of COVID-19 to a National Institutes of Health (NIH) database in December 2019, two weeks before Beijing released the virus’s genome sequence, according to federal documents obtained by a House committee. The House Energy and Commerce Committee obtained documents from the Department of Health and Human Services (HHS) confirming that Lili Ren, a virologist at the Institute … |
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Upcoming news themes and events we’re watching: |
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The Senate HELP Committee will hold a hearing Thursday about long COVID.
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Branch out with a different read from The Hill: |
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South Dakota House passes bill that would make the animal sedative xylazine a controlled substance |
PIERRE, S.D. (AP) — The South Dakota House passed a bill Wednesday that would make xylazine, an animal sedative that is being mixed with fentanyl and then used by some people, a controlled substance. The measure, which passed unanimously in the Republican-held House and now goes to the Senate, would establish penalties of up to two years … | |
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Local and state headlines on health care: |
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‘I’m not safe here’: Schools ignore federal rules on restraint and seclusion (KFF Health News)
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State Health Plan no longer covering new Ozempic and WeGovy prescriptions (Queen City News)
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100 Kansas hospital and clinic executives, health professionals endorse Medicaid expansion (Kansas Reflector)
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Health news we’ve flagged from other outlets: |
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Disease X: What to know about the hypothetical pandemic world leaders hope to prevent (USA Today)
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Moms are still struggling to get RSV shots for their babies (The 19th News)
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Cancer deaths are falling, but there may be an asterisk (The New York Times)
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Most read stories on The Hill right now: |
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The Supreme Court’s conservatives appeared inclined to cut back the regulatory power of federal agencies, with several justices during a pair of arguments Wednesday seeming … Read more |
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President Biden and congressional leaders in both parties are ramping up pressure on Speaker Mike Johnson (R-La.) to accept an expected deal on Ukraine … Read more |
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You’re all caught up. See you tomorrow! |
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