Health insurers again win lobbying battle with doctors and hospitals over prior authorization of procedures, treatments
By Melissa Patrick
Kentucky Health News
A bill to exempt health-care providers who have 90% or more of their claims approved from health-insurance companies’ requirements for prior authorization of ceratin treatments has failed again.
“Unfortunately House Bill 317 looks like it’s dead,” said its sponsor, state Rep. Kim Moser. “We tried in good faith to work out a compromise and we did not have the same reciprocation. And so, you know, I’m not exactly sure why it didn’t get a hearing.”
HB 317 was placed in House Banking and Insurance Committee and had two of its three required readings to be heard on the House floor, but it was never called up for a hearing. The last regular day for final passage of a bill is Thursday, March 28.
Moser said her bill is important because it would ensure timely treatment and care that has been prescribed by a person’s health care provider.
“It’s really about making sure that patients get the care that they need when they need it,” she said. “I think that there is a way to find a process that expedites the care that patients can get – and this is it.”
Asked what concessions she had made with the insurance companies, Moser said, “We removed Medicaid, which was huge.”
That only left the 450,000 patients on the state-regulated plans, which would have provided a snapshot of whether the change would work, she said.
“We weren’t calling it a pilot, but you know, it would allow us to really look at how this helped, or if it didn’t help at all,” she said. ” And, you know, that’s all we wanted was to be able to see how it works and see if this is a process that, like I said, (would) expedite the care that patients can receive.”
Physicians say the system undermines their medical judgement, and increases their administrative costs.
“The current prior authorization process leads to delays for patients, administrative burdens for physicians, and increased costs,” KMA President Dr. Michael Kuduk said in a Feb. 21 news release. “It’s time for us to pass a common-sense solution that doesn’t harm our patients or overburden our healthcare system.”
Allowing exemptions based on past performance has been dubbed a “gold carding program.” KFF Health News reported Feb. 12 that five states have passed some form of it: Louisiana, Michigan, Texas, Vermont and West Virginia, and the American Medical Association is tracing active gold-carding bills in 13 states.
Kentucky won’t be one of them, at least this year, despite the strong lobbying efforts of the Kentucky Hospital Association and the Kentucky Medical Association. Moser said this is the third year she has worked on this effort.
Asked about the bill’s failure, Cory Meadows, KMA’s deputy executive vice-president and director of advocacy, issued a statement saying the groiup “is extremely disappointed by HB 317’s failure to pass during the 2024 legislative session. KMA members expressed the need for changing the prior-authorization process used by insurers that limits, and in some cases prevents necessary health care to Kentuckians. Throughout these past several months, citizens from around the commonwealth also shared their own stories of how the prior-authorization system impacted their lives, clearly showing that nearly everyone except insurance companies see the need to change this system.
“We’re encouraged by the overwhelming bipartisan support the measure received and remain extremely optimistic that with continued advocacy from our members and the public, as well as collaboration with lawmakers, this critical legislation, which proposes to streamline the prior authorization process and ensure patients have timely access to care will soon be enacted. Otherwise, insurers will continue to pocket the money that could make Kentuckians healthier.”
The hospital association also expressed its disappointment.
Asked about the bill’s demise, Tyler Glick, KAHP spokesman, issued this statement: “The health mandate statement generated by the Department of Insurance says the bill would cost up to an additional $11.29 in health-insurance premiums per member per month. That means a family of four would pay an additional $541.92 a year. How is saddling taxpayers (Medicaid), state employees and teachers (Kentucky Employees Health Plan), and everyone else in the commercial insurance market with these costs sound policy? Kentuckians deserve better.”
Glick added, “KAHP will continue working with all members of the General Assembly to promote affordability, expose waste and fraud, and provide safeguards to patients.”