May 5, 2023: State Advocacy Update


Momentum continues in the states to reform the burdensome and harmful prior authorization (PA) process. 

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Recently, the North Carolina House passed a bipartisan reform bill, House Bill (HB) 649 (PDF), by a vote of 112-0. The North Carolina Medical Society is strongly supporting HB 649, which includes provisions to improve the PA process, protect patients from care disruptions as a result of such requirements, and reduce the overall volume of PAs, and is working to build support in the Senate. The AMA is also supporting NC HB 639 (PDF), recognizing that this important legislation would help to right-size the PA process in North Carolina by reducing the burden of PA on patients, physicians and the health care system.   

Meanwhile, PA reform legislation in the District of Columbia has been introduced and the D.C. Council’s Committee on Health is holding a hearing on May 24 (PDF) to consider this important bill. The “Prior Authorization Reform Amendment Act of 2023” (B25-0124) is a top priority for the Medical Society of the District of Columbia (MSDC), as the bill would increase PA transparency, reduce the need for repeat prior authorizations, ensure adverse determinations are made by qualified physicians, and require public reporting of health plans’ PA statistics, among many other provisions. MSDC is working hard to build support for the legislation prior to and at the May hearing. The AMA is supporting (PDF) this consequential PA reform bill.        

In a recent letter (PDF), the AMA urged Governor Jay Inslee of Washington State to veto Senate Bill (SB) 5389, which would allow optometrists to perform surgical procedures on the eye and prescribe a broader range of pharmaceuticals. The types of complex surgical procedures that optometrists would be authorized to perform under SB 5389 require specialized medical education and training that optometrists do not receive. While training for ophthalmologists includes four years of medical education and an additional four to six years in postgraduate residencies and fellowships, optometrists are not required to complete any postgraduate advanced training. SB 5389 would put patient safety and the highest quality of care at risk.  

The AMA sent a separate letter (PDF) in strong opposition to Nevada Assembly Bill (AB) 364, legislation which would drastically increase the scope of practice of physician assistants and completely remove physician supervision. While the AMA values physician assistants as members of the physician-led health care team, physician assistants receive their education under the assumption that, in practice, there will be a high degree of physician supervision or collaboration. A number of studies outlined in the letter also reveal that physician assistants and other non-physicians practicing without any physician involvement increase health care costs and achieve worse patient outcomes. 

The AMA is supporting a bill in Michigan with key policies that support patient access to high-quality telemedicine. In a recent letter (PDF), the AMA expressed strong support of Michigan House Bill (HB) 4131, legislation that includes provisions which would “provide clear guidance on policy measures that support the best course forward for high-quality care, including access to care in rural and underserved communities.” 

In particular, the AMA supports provisions in HB 4131 related to the following: 

  • Coverage parity, which “ensures that patients will continue to have access to telemedicine, including from their regular physician.”  
  • Fair and equitable payment policies, which “support physician investment and integration of telemedicine in their practice.” 
  • Network adequacy, with language specifying that “telemedicine-only providers should not be used to meet network adequacy requirements.” 

The AMA is opposing a Maine bill that would take the state backwards in its harm reduction efforts when there is a drug-related overdose. In a recent letter (PDF), the AMA expressed opposition to Maine Legislative Document (LD) 714, “An Act to Expand the List of Crimes That Do Not Qualify for Immunity Under Maine’s Good Samaritan Laws Concerning Drug-related Medical Assistance.”  

“If passed, LD 714 would have the unintended effect of causing fear among bystanders when there is a drug-related overdose, inevitably leading fewer people to call for help and thereby increasing the likelihood of harm, including death,” said AMA Executive Vice President and CEO, James L. Madara, MD. 

Dr. Madara highlighted the AMA’s support for policies and legislation that provide protections for callers or witnesses seeking medical help for anyone who experiences a drug-related overdose. Good Samaritan laws’ positive effects were reported by the U.S. Government Accountability Office, which found that these laws help reduce opioid-related mortality.  

Rather than help the situation in Maine, Dr. Madara said that “by reducing and effectively eliminating protections for certain bystanders, LD 714 will result in fewer calls for help to first responders and likely increase overdose fatalities.” Dr. Madara called LD 714 “a significant step in the wrong direction.”