THE OUTLOOK FOR HEALTH CARE IN 2023:

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September 16, 2022

Around the nation: House passes prior authorization legislation for MA plans

Daily Briefing

    The House on Wednesday passed the Improving Seniors' Timely Access to Care Act, which would streamline the prior authorization process for Medicare Advantage (MA) plans, in today's bite-sized hospital and health industry news from the District of Columbia, Georgia, and Illinois.

    • District of Columbia: The House on Wednesday passed the Improving Seniors' Timely Access to Care Act, which would streamline the prior authorization process for MA plans. Under the legislation, MA insurers would be required to use electronic prior authorization programs, submit lists of items and services subject to prior authorization each year, and follow beneficiary protection standards. The bill, which was introduced in 2019, is a bipartisan health care initiative with over 300 cosponsors in the House. In addition, the legislation has gained the support of provider and insurance groups. "Hospitals and health systems commend the U.S. House of Representatives for their passage of the Improving Seniors' Timely Access to Care Act," said American Hospital Association (AHA) EVP Stacey Hughes. "In particular, we thank Reps. DelBene, Kelly, Bera and Buschon and the leadership of the Ways and Means and Energy and Commerce Committees for their work on this important issue. This legislation takes important steps to reduce the burden and complexity of prior authorization requirements imposed by Medicare Advantage plans. These provisions will help Medicare patients access the care they need in a timely manner while reducing the strain on our already taxed health care workforce. The AHA is encouraged by Senate support on companion legislation and urges them to take action on these critical protections." (Goldman, Modern Healthcare, 9/14; AHA News, 9/14)
    • Georgia: CDC announced that the World Health Organization (WHO) has added the United States to its list of countries with vaccine-derived poliovirus circulating in the population. Currently, the list includes around 30 other countries, including Israel and the United Kingdom. Vaccine-derived poliovirus is transmitted between individuals who have received the oral polio vaccine and pass some of the weakened virus from the vaccine to another individual. The virus can spread among unvaccinated individuals through person-to-person contact or air droplets from a sneeze or cough. "We cannot emphasize enough that polio is a dangerous disease for which there is no cure," said José Romero, CDC director at the National Center for Immunization and Respiratory Diseases. (Dreher, Axios, 9/14)
    • Illinois: AHA on Tuesday commented on CMS' proposed calendar year (CY) 2023 payment rule for hospital outpatients and ambulatory surgery centers in a letter sent to CMS Administrator Chiquita Brooks-LaSure. In the letter, AHA expressed support for CMS' decision to stop making cuts to 340B hospitals. They encouraged CMS to reinstate 340B hospital payments for CY 2018 to CY 2022 with no penalties for other hospitals. In addition, they voiced support for CMS' proposal to calculate the monthly facility rates for rural emergency hospitals using Medicare claims data. However, AHA strongly recommended CMS increase the rule's market basket update, calling it insufficient and saying it does not reflect the inflationary environment hospitals and health systems operate within. (Tucker, Becker's Hospital Review, 9/14)

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