Advocacy Update

Nov. 29, 2018: State Advocacy Update


Register now for the 2019 AMA State Advocacy Summit (formerly the State Legislative Strategy Conference) which will be held Jan. 10-12 in Scottsdale, Arizona. The program will focus on how to successfully advocate during turbulent times.

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Sessions will cover topics such as:

  • Harnessing the power of the physician voice
  • Protecting patients in a changing regulatory environment
  • Restoring and improving access to care in the individual market
  • Reversing the opioid epidemic
  • Navigating a post-consolidation world
  • Regulating pharmacy benefit managers

Join Jack Resneck Jr., MD, chair of the AMA Board of Trustees, and others who are ready to address the issues all physicians are facing at the state level. Register now for both the SAS and the National Advocacy Conference and save 20 percent.

The American Psychiatric Association (APA) has created state-specific legislation to help implement the Mental Health Parity and Addiction Equity Act (MHPAEA) for all 50 states. Provisions within the APA model legislation and AMA model legislation are closely aligned. Despite the fact that MHPAEA was enacted over a decade ago, many insurers are still not compliant with the law, particularly in regard to how they design and apply managed care practices such as prior authorization, step therapy, and payment rate setting, among others.

The APA and AMA model language requires insurers to submit analyses demonstrating their compliance with the law regarding the design and application of managed care practices. The legislation also requires state regulators to enforce MHPAEA and report on their implementation activities. APA staff has made the introduction of legislation easier by formatting 50 individual bills that amend the correct sections of state law, and uses the proper terminology used in that state to describe insurers, mental health conditions and substance-use disorders, and insurance regulators. Legislation similar to this model language has already been signed into law in states such as Delaware, Illinois, and Tennessee.

For more information about the APA model bill, please contact Tim Clement at [email protected].

For more information about the AMA model bill, please contact Daniel Blaney-Koen at [email protected].

Jack Resneck Jr., MD, chair of the AMA Board of Trustees, presented before the National Association of Insurance Commissioners (NAIC) on Nov. 16 and encouraged the nation's insurance regulators to enforce and support states laws that ensure patient access to covered benefits. For example. Dr. Resneck identified prior-authorization requirements as a major reason why covered care may be delayed or denied and an area where greater enforcement of state laws is needed.

Not only will better regulation of utilization-management programs improve individual patient outcomes, but such regulation may prevent spending on eventual costly care when patients are initially denied a prescription, an ultrasound, an MRI, physical therapy, a biopsy, specialty care or other services.

Dr. Resneck also discussed the need for improved regulation of provider networks, including meaningfully evaluating networks for hospital-based providers, to again ensure access to covered benefits and value for premiums paid.

The AMA is working to stop prior authorization and other administrative barriers from standing in the way of patients' access to covered care. Visit for resources and tools for patient and physician advocates, and to share your story about how utilization management has stood in the way of patient care.