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NCOIL considers model prior authorization legislation and discusses use of AI in the claims process
The National Council of Insurance Legislators (NCOIL), a leading organization comprised of legislators serving on state insurance and financial institutions committees, met in Chicago last week for its annual summer meeting.
NCOIL’s Health Insurance and Long-Term Care Issues Committee held its third discussion on draft model prior authorization legislation, and the AMA was again invited to speak to the issue and the draft bill. AMA’s comments at the meeting reflected a recent AMA redlined-version of the NCOIL draft (PDF) submitted to the committee that includes asks to strengthen the qualifications of the health plan reviewer, decrease response times, improve patient continuity of care, and align automation requirements with federal standards. The AMA was joined by the Leukemia and Lymphoma Society and the American Hospital Association in urging NCOIL to move forward with a strong model bill for states legislators.
Also discussed at the recent NCOIL meeting was the use of artificial intelligence (AI) in the insurance claims process, and the possibility of NCOIL developing model legislation to establish guardrails in this space. The AMA highlighted the excitement physicians have in the promise of AI in health care and particularly its potential to reduce administrative burdens on physician practices. However, the AMA expressed concern about the use of AI to deny medical claims and the need for meaningful review by qualified physicians on any adverse determination, as well as improved transparency on the use of AI in these processes for patients and physicians. Despite opposition to a model bill from the speakers representing the insurance sectors, legislators seemed interested in continuing the conversation.
AMA supports prior authorization reform in Massachusetts
The AMA joined a panel including the Massachusetts Medical Society, Health Care for All, and the Massachusetts Health & Hospital Association testifying in support of legislation to reform the prior authorization process (S. 1403) in the Massachusetts Joint Committee on Health Care Financing last week. AMA testimony provided a national perspective on state prior authorization reform efforts, including the value in strong data collection efforts, automation and patient protections from disruptions in care caused by the prior authorization process. The AMA also expressed optimism over recently announced voluntary pledges by several national health plans to improve the prior authorization process, but urged legislators to move forward with statutory reforms, stating that these voluntary pledges are not a signal to take our foot off the gas in terms of legislation, but rather an opportunity to codify these pledges into law and create accountability.
Massachusetts legislation would phase out sale of tobacco products
Legislation being considered by the Massachusetts Legislature would seek to phase out the commercial availability of tobacco products. House Bill 2562 and Senate Bill 1568 would prohibit the sale of tobacco products to individuals born on or after Jan. 1, 2006, with the goal of protecting future generations from the lifelong harms of nicotine addiction and tobacco use.
“By advancing H. 2562 and S. 1568, Massachusetts has an opportunity to set a national precedent and take a meaningful step toward ending the cycle of addiction and disease caused by tobacco and nicotine products,” AMA CEO and EVP John Whyte, MD, MPH, wrote in a letter (PDF) supporting the legislation. “We believe that initiatives like this are critical components of a broader, multi-pronged strategy to end the use of tobacco and nicotine products.”
The AMA has long been an advocate against tobacco use, which remains the leading cause of preventable death in the U.S.
