AHA issues letter of support for 'gold card' legislation

The American Hospital Association, which represents 5,000 member hospitals, 270,000 affiliated physicians and 2 million nurses and caregivers, has authored a letter in support of proposed House Resolution 4968, the GOLD Card Act of 2023. 

The GOLD Card Act would exempt qualifying providers from prior authorization requirements under Medicare Advantage plans, according to the letter published Aug. 28. 

It would exempt providers from requiring prior authorizations under Medicare Advantage plans if they had at least 90 percent of their prior authorization requests approved in the preceding year. It would limit reviews for "gold card" status to once every 12 months. 

"America's hospitals and health systems support gold carding programs, which substantially reduce administrative burdens and costs and streamline access to care for Medicare beneficiaries," the AHA wrote. "Gold carding programs help eliminate unnecessary delays in care by enabling providers who have demonstrated consistent adherence to evidence-based guidelines to be granted exemptions from prior authorization requirements."

In June, insurer UnitedHealthcare announced its intentions to begin a similar gold card program in 2024 for certain gastrointestinal procedures. 

Its gold card announcement was met with anger from industry groups, including the Digestive Health Physicians Association and the American Gastroenterological Association. Both groups issued statements urging the insurer to withdraw the gold carding plans, mostly due to UHC's proposed "advanced notification" system, which the groups say is just as burdensome as prior authorization. 

"(UHC) has provided few details about this 'gold card program,' which unfortunately seems to require the same waste of our resources and time to provide UHC with data. Why do physicians need to prove to insurance companies that we are worthy of their covering our procedures when it really should be the other way around, where insurance companies must be held accountable for their actions that are frequently deleterious to patients' well-being and mainly focused on their bottom line?" gastroenterologist Linda Lee, MD, medical director of endoscopy at Boston-based Brigham and Women's Hospital and associate professor of medicine at Harvard Medical School, told Becker's in June. 

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