ADVOCACY

Capitol Hill Report

Capitol Hill Report presents regular updates on legislative and regulatory actions and how the Academy ensures that the voice of neurology is heard on Capitol Hill. It is emailed to US members twice monthly and is posted at AAN.com/view/HillReport. Below are some recent highlights.

Issue In Focus

Reducing the administrative burdens faced by neurologists is a long-standing priority for the AAN.

The AAN works to address administrative burdens across multiple fronts to ensure that clinicians can spend more time on patient care and less on administrative tasks. Prior authorization (PA) in particular is often cited as a top concern among AAN members. PA is one of the most time-consuming and expensive administrative requirements preventing physicians from spending more time with patients. Over 90 percent of clinicians reported that PA requirements have a negative impact on patient clinical outcomes and 82 percent of clinicians reported that issues associated with PA can lead to patients abandoning a recommended course of treatment. A recent member survey indicated that AAN members believe addressing administrative burden associated with PA should be the AAN’s top priority for 2023.

On January 30, the AAN submitted comments to CMS urging the agency to implement a number of critical reforms to improve oversight of Medicare Advantage (MA) plans’ usage of PA. These comments are a critical element in several years of efforts to pressure CMS to address the growing PA burden in MA. The AAN was deeply disturbed by April 2022 findings from the Department of Health and Human Services Office of Inspector General relating to inappropriate PA denials which found that some PA requests were denied by MA plans, even though the requested services met

Medicare coverage guidelines The AAN strongly believes that Medicare beneficiaries enrolled in MA plans have the same access to covered services as those covered under Medicare Fee-for-Service. Key reforms contained in this proposed rule include: strengthening of evidentiary standards plans must use when developing PA policies, requiring greater alignment of MA PA policies with those in Medicare FFS, restrictions on the use of PA when patients transition between plans, and changes impacting reviewers of adverse decisions.

The AAN will continue its efforts to reduce PA-related burden and is currently working to draft additional comments to CMS in support of proposals advancing interoperability and improving the electronic exchange of health care data to streamline prior authorization processes. The AAN recognizes the importance of codification in legislation of important policies that prevent overly burdensome barriers to care. Last Congress, the Improving Seniors Timely Access to Care was one of the most widely supported bills, with 327 House and 53 Senate co-sponsors. The bill is likely to be reintroduced this Congress, pending reevaluation of the cost estimate from the Congressional Budget Office. AAN staff are keeping a close eye on this and other key legislative developments related to prior authorization. 