Eligible providers would be exempt from pre-authorization requirements under Medicare Advantage plans if legislation recently introduced by U.S. Representative Michael Burgess (R-TX) is signed into law.
“Before coming to Congress,” Rep. Burgess said, “I practiced medicine for nearly 30 years and I understand the frustration that comes with waiting for the government to tell me if I can provide certain treatments for my patients. of Medicare”.
On June 9, the congressman sponsored the Physician Long Delay Care Act of 2022, also known as the GOLD CARD Act of 2022, HR 7995, with the original lead co-sponsor, U.S. Representative Vicente Gonzalez (D-TX).
“I am grateful to my fellow Texan, Congressman Vincente Gonzalez, for joining me in introducing this essential legislation that will ensure patients receive quality care in a timely manner by streamlining the prior authorization process for doctors,” Rep. Burgess said. “I have seen support for this legislation in my home country and I am confident that the GOLD patent policy will be effective in improving clinical outcomes.”
If enacted, HR 7995 would exempt providers from requiring pre-authorization for a Medicare Advantage plan year if the provider had at least 90% of pre-authorization requests approved in the previous year, according to a bill summary provided by Representative Burgess staff.
Additionally, HR 7995 would allow a Medicare Advantage plan to revoke a provider’s Gold Card status in that plan year if fewer than 90% of claims submitted were approved for preauthorization or in the case of fewer than 10 applications submitted, less than 90% of the last 10 applications submitted would have been approved for prior authorization, the summary indicates.
Among other provisions, the bill would also allow physicians to appeal Gold Card revocations they believe were improperly decided, the summary says.
“I am proud to introduce the GOLD CARD Act with Dr. Burgess to remove barriers preventing patients from receiving the care they deserve,” Rep. Gonzalez said. “No one’s care should be suspended by red tape.”
The American Medical Association, American Association of Neurological Surgeons/Congress of Neurological Surgeons Washington Committee and Texas Hospital Association have endorsed the bill.