IOMS Call to Action: Prior Authorizations
Illinois Osteopathic Physicians and Medical Students:
On February 5, 2021, the Illinois State Medical Society (ISMS) hosted a virtual meeting collaboratively with leadership of various professional societies (ISMIE, Illinois Hospital Association, Illinois Osteopathic Medical Society (IOMS) and others) regarding legislation to fix the problems faced through the Prior Authorization process. The IOMS was well represented by Dr. Mizera, Dr. Hubka and Tabitha Arnett, IOMS Executive Director. February 8, 2021, a new bill (HB 711) was introduced to the IL General Assembly regarding the critical issues related to patient’s access to care and extreme hardships placed on physician’s practices due to the current process of Prior Authorizations. The purpose of this bill is not to focus on any single medical specialty’s issues, or any specific procedural type, but to focus on "reforming" the general process involved in Prior Authorizations.
Goals of HB 711:
1. Obtain a commitment to a standardized timeline for responses. (i.e.: 24 hours for emergent issues and 72 hours for non-emergent issues).
2. Provide transparency of the criteria used in the decision-making process for approval or denial
3. Improve the Peer-to-Peer process by requiring a peer discussion be between providers of equal or equivalent level of training/professional degree and specialty experience for ultimate decision making in the approval process.
4. Provisions for continuity of care in situations where a patient is transitioning carriers or insurance entities that may have mandatory waiting periods, etc.
IOMS’s position is the current prior authorization process is cumbersome which delays and obstructs appropriate patient care; thus, patients become sicker driving up the cost of overall care when not performing certain lab or imaging tests, specific procedures, medication management, etc. ISMS leadership stated there is stiff opposition by insurers and others to make any changes to the current process.
IL State Representative Mr. Greg Harris (D-Chicago) and IL Senator Ms. Linda Holmes (D- Aurora) are the two legislators who are introducing and sponsoring the bill in each IL House. Visit YourCareCantWait.org for more information.
Please contact your legislators, speak out regarding this issue, and spread the word to colleagues. The ISMS is looking for personal patient experiences with the prior authorization process that delayed care, and detrimentally affected the patient, to support its position.
Other issues briefly addressed:
- HB 3559 would create a Mandatory Dementia-Specific Training Act requiting mandatory education and training of all physicians regarding Alzheimer's disease, dementia symptoms and care. The position of mandatory education is not supported for specific disease states and should be up to the specialty societies. IOMS supports that optional CME opportunities can be provided through individual specialty societies.
- Speak up now before it’s too late! Urge Governor Pritzker to VETO HB 3360. This punitive bill sponsored by Illinois trial lawyers, was passed in January by a lame duck congress without any hearing or public comments. It imposes an additional 9% prejudgment interest, to be paid in personal injury and wrongful death lawsuits, backdated to the time the defendant was made aware of the injury. Either call the Governor’s office or use this IOMS and AOA Action Alert link to voice your objection! Action Alert: https://osteopathic.quorum.us/campaign/30973/
To contact Governor Pritzker:
Address: State Capitol, 207 Statehouse, Springfield, IL 62706
Phone: 217-782-6830
Fax: 217-524-4049
To find your legislator regarding the Prior Authorization issues or other issues:
Visit https://www.elections.il.gov/ElectionOperations/Districtlocator/Addressfinder.aspx
We will continue to represent IOMS on these important issues and keep you informed.
Sincerely,
Kim Huntington-Alfano, DO, MBA, CS
IOMS President Elect and Legislative Committee, Chair
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