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Skip to main content Menu * Delivering Care * 1. Delivering Care 2. Coronavirus 3. AMA Guides® 4. Health Equity 5. Public Health 6. Physician-Patient Relationship 7. Overdose Epidemic 8. Hypertension 9. Diabetes 10. Population Care 11. Precision Medicine 12. Patient Support & Advocacy 13. Ethics COVID-19 (2019 NOVEL CORONAVIRUS) RESOURCE CENTER FOR PHYSICIANS The AMA is closely monitoring COVID-19 (2019 novel coronavirus) developments. Learn more with the AMA's COVID-19 resource center. 12 SYMPTOMS OF LONG COVID, FDA PAXLOVID APPROVAL & MPOX VACCINES WITH ANDREA GARCIA, JD, MPH The AMA Update covers a range of health care topics affecting the lives of physicians and patients. Learn more about the 12 symptoms of long COVID and more. * Practice Management * 1. Practice Management 2. AMA STEPS Forward® 3. AMA Store 4. Practice Transformation 5. CPT® 6. Prior Authorization 7. Reducing Administrative Burden 8. Scope of Practice 9. Sustainability 10. Physician Health 11. Claims Processing 12. Private Practices 13. Payment & Delivery Models 14. Medicare & Medicaid 15. Digital 16. HIPAA 17. Career Development AUGMENTED INTELLIGENCE IN MEDICINE The AMA is committed to helping physicians harness AI in ways that safely and effectively improve patient care. CPT® NETWORK Subscribe to the AMA’s CPT® Network for tools to research a knowledge base of FAQs and clinical examples. * Education * 1. Education 2. Online Learning & CME 3. AMA PRA Credit System 4. Improve GME 5. GME Funding 6. Medical School Diversity 7. ChangeMedEd Initiative 8. International Medical Education CATALYZING CHANGE IN MEDICAL EDUCATION Through the new AMA ChangeMedEd® initiative, the AMA is concentrating on developing the foundational attributes of precision education and its real-world application via investments in new partnerships and exploratory pilots. Learn more. DEVELOPING FLEXIBLE, COMPETENCY-BASED PATHWAYS See how medical education is shifting away from classrooms and toward activities and assessments that help students succeed in the modern health care system. * Medical Students * 1. Medical Students 2. Preparing for Medical School 3. USMLE® Step 1 & 2 4. Medical School Life 5. Medical Student Health 6. Medical Student Finance 7. Clinical Rotations 8. Publishing Research 9. Medical Student Advocacy 10. Specialty Profiles 11. Preparing for Residency MEDICAL STUDENT OUTREACH PROGRAM (MSOP) Learn about the student program, where AMA members receive recognition and support for outreach activities and earn rewards. MEDICAL STUDENT OUTREACH PROGRAM (MSOP): OUTREACH LEADER RECRUITMENT RESOURCES MSOP Outreach Leaders: Find all of the information you need for the year, including the leader guide, action plan checklist and more. * Medical Residents * 1. Medical Residents 2. Residency Life 3. Research During Residency 4. Medical Fellowships 5. Medical Resident Wellness 6. Medical Resident Advocacy 7. Medical Residency Personal Finance 8. USMLE® Step 3 9. Transition from Resident to Attending 4 THINGS MEDICAL STUDENTS SHOULD KNOW ABOUT PRIVATE PRACTICE Trained emergency physician Omar Maniya, MD, now leads a primary care practice. Learn his advice for medical students about this practice setting. RED FLAGS, MUST-HAVES FOR YOUNG DOCTORS IN CONTRACT NEGOTIATIONS Before you sign on the dotted line in your first or second physician career stop, learn with the AMA about what to look for—and avoid—in employers. * Health Care Advocacy * 1. Health Care Advocacy 2. Advocating for Public Health 3. Access to Care 4. Administrative Burdens 5. Payment Reform 6. Advocacy Update 7. Federal Advocacy 8. State Advocacy 9. Judicial Advocacy AMA ADVOCACY INSIGHTS WEBINAR SERIES AMA Advocacy Insights webinar series examines key advocacy issues from the federal and state levels impacting patients and physicians. MAY 19, 2023: ADVOCACY UPDATE SPOTLIGHT ON "MEDICARE BASICS" SERIES New “Medicare basics” series offers background for advocates and more in the latest Advocacy Update spotlight. * Member Benefits * 1. Member Benefits 2. Personal Member Benefits & Discounts 3. Practice Benefits & Discounts 4. Member Eligibility & Dues AMA MEMBERSHIP DUES See the costs for all the AMA membership categories, plus tax deduction information. AMA RESIDENT & FELLOW MEMBERSHIP, DISCOUNTS AND BENEFITS Find information for AMA resident and fellow membership, discounts and benefits. * ORGANIZATION * Board of Trustees * House of Delegates * 1. House of Delegates 2. HOD Organization 3. AMA Policies 4. Special Meeting 5. Annual Meeting 6. Interim Meeting 7. 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Masterfile 2023 ANNUAL MEETING OF THE AMA HOUSE OF DELEGATES Officials and members gather to elect officers and address policy at the 2023 AMA Annual Meeting being held in Chicago, June 9-14, 2023. AMA’S CENTER FOR HEALTH EQUITY MISSION AND GUIDING PRINCIPLES Learn about the AMA’s Center for Health Equity mission and guiding principles for embedding health equity within the association and the medical profession. * EXPLORE PRODUCTS * JAMA Network™ * FREIDA™ * AMA Ed Hub™ * COVID-19 Resources * AMA Journal of Ethics® * CPT * Store * AMA Insurance * AMA Physician Profiles Join Renew Join / Renew Member Benefits Sign In * Sign In * Create free account * Join/Renew * Member Benefits My Subscriptions My Topics My Bookmarks Prior Authorization BILLS IN 30 STATES SHOW MOMENTUM TO FIX PRIOR AUTHORIZATION MAY 10, 2023 4 MIN READ KEVIN B. O'REILLY News Editor Twitter logo Bookmark Print Page What’s the news: A majority of U.S. states are considering legislation to rightsize the time-wasting, care-delaying payer practice of prior authorization. In all, nearly 90 prior-authorization reform bills have been considered this legislative session in 30 states, and more than a dozen are still on the table for potential passage. YOUR POWERFUL ALLY The AMA helps physicians build a better future for medicine, advocating in the courts and on the Hill to remove obstacles to patient care and confront today’s greatest health crises. Limited time: You may be eligible for half-price dues. Learn more! Join the AMA That includes legislation in Arkansas, California (PDF), New Jersey (PDF), North Carolina (PDF), Washington, D.C. (PDF), and Washington state. Many of the bills draw on the AMA’s model legislation (PDF) and encompass prior-authorization reforms to: * Establish quick response times (24 hours for urgent, 48 hours for nonurgent care). * Allow adverse determinations only by a physician licensed in the state and of the same specialty that typically manages the patient’s condition. * Prohibit retroactive denials if care is preauthorized. * Make authorization valid for at least one year, regardless of dose changes; and for those with chronic conditions, the prior authorization should be valid for the length of treatment. * Require public release of insurers’ prior authorization data by drug and service as it relates to approvals, denials, appeals, wait times and more. * Require a new health plan to honor the patient’s prior authorization for at least 90 days. * Reduce volume through the use of solutions such as prior authorization exemptions or gold-carding programs. "The momentum behind prior-authorization reform feels powerful right now, with dozens of bills in state legislatures this year and advocates laying the groundwork for next year," said AMA President Jack Resneck Jr., MD. "These efforts join major reforms at the federal level being proposed and finalized. Policymakers and other stakeholders seem to be realizing what patients and physicians have known for a long time—prior authorization harms patients, undercuts clinical decision making and wastes valuable health care resources." RELATED COVERAGE 1 in 3 doctors has seen prior auth lead to serious adverse event The progress at the state level comes as the Centers for Medicare & Medicaid Services (CMS) has taken action at the federal level, releasing a final rule (PDF) last month that revises Medicare Advantage prior-authorization program requirements. In February, the AMA and nearly 120 physician organizations sent a letter (PDF) to CMS Administrator Chiquita Brooks-LaSure in strong support of the proposed prior-authorization changes, and many of the provisions have been finalized. > Fixing prior authorization is a critical component of the AMA Recovery Plan > for America’s Physicians. > > Prior authorization is overused, and existing processes present significant > administrative and clinical concerns. Find out how the AMA is tackling prior > authorization with research, practice resources and reform resources. Why it’s important: As AMA Executive Vice President and CEO James L. Madara, MD, explained in a letter (PDF) supporting New Jersey Assembly Bill 1255, “AMA survey data released earlier this month show that 94% of physicians report care delays because of prior authorizations. The same survey [PDF] found that 89% of physicians saw prior authorization as having a negative effect on their patients’ clinical outcomes and 80% of the physicians surveyed indicated that patients abandon treatment due to authorization struggles with health insurers. “Alarmingly, AMA data also show that 33% of physicians report that prior authorization has led to a serious adverse event for a patient in their care, such as hospitalization, permanent impairment or death,” Dr. Madara wrote in the letter to the chair of the state assembly’s Financial Institutions and Insurance Committee. The New Jersey bill, like others advanced in legislatures across the country, “would go a long way in reducing patient harm as a result of prior-authorization requirements,” he added. The Medical Society of New Jersey supports A1255, said Josh Bengal, director of government relations and staff counsel there. RELATED COVERAGE How doctors shaped prior-auth reforms in Medicare Advantage “Our ongoing conversations with legislative leadership revolve around the dire need to support our physician and patient communities, especially in the wake of the pandemic,” Bengal said. “We hope these critical bills will move forward before the legislature’s summer recess.” Learn more: Patients, physicians and employers can learn more about reform efforts and share personal experiences with prior authorization at FixPriorAuth.org. Visit AMA Advocacy in Action to find out what’s at stake in fixing prior authorization and other advocacy priorities the AMA is actively working on. Explore Series AMA Recovery Plan for Physicians Active State 2 More about: * Prior Authorization * Prior Authorization Survey * State Advocacy * Catalog of Topics ESSENTIAL TOOLS & RESOURCES National advocacy priorities and wins State advocacy: shaping policy at the state level Current Litigation Center cases AMA Recovery Plan for America's Physicians AMA advocacy in action AMA advocacy efforts RELATED CONTENT Operating rules are “secret weapon” to fight burdens and burnout How prior authorization disrupts patient care, Part II Prior authorization practice resources Featured Stories LEADERSHIP VIEWPOINTS PROTECTING REPRODUCTIVE HEALTH CARE MEANS PROTECTING PHYSICIANS DELIVERING CARE THE COVID-19 PUBLIC HEALTH EMERGENCY IS OVER. NOW WHAT? PRACTICE MANAGEMENT WHEN WILL THE LAWSUIT COME? FOR DOCTORS, IT’S A MATTER OF TIME IT’S TIME TO REBUILD The AMA Recovery Plan for America’s Physicians renews our commitment to physicians so patients can receive the high-quality care they deserve. Let’s Get Started PRIOR AUTHORIZATION AMA prior authorization resources help physicians advocate for reform, improve practice efficiency and use data to highlight how insurers’ barriers to necessary care hurts patients. Get the Support You Need Also of Interest: * Health Information Technology * Harm Reduction Centers * Gun Violence The AMA promotes the art and science of medicine and the betterment of public health. * * * * * AMA Contact Us Download AMA Connect app for iPhone or Android * AMA Careers * Events * Press Center * AMA Alliance * AMPAC * AMA Foundation The best in medicine, delivered to your mailbox Email I verify that I’m in the U.S. and agree to receive communication from the AMA or third parties on behalf of AMA. * JAMA Network™ * FREIDA™ * AMA Ed Hub™ * COVID-19 Resources * AMA Journal of Ethics® * CPT * Store * AMA Physician Profiles * AMA Insurance * Terms of Use * Privacy Policy * Code of Conduct * Website Accessibility Copyright 1995 - 2023 American Medical Association. All rights reserved. ✓ Thanks for sharing! AddToAny More…