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Medical Group Management Association

June 5, 2019: MGMA supports prior authorization legislation for MA plans

Advocacy Letter - June 5, 2019

June 5, 2019

The Honorable Suzan DelBene
2330 Rayburn House Office Building 
Washington, DC 20515 

The Honorable Mike Kelly
1707 Longworth House Office Building 
Washington, DC 20515  

The Honorable Roger Marshall, MD
312 Cannon House Office Building  
Washington, DC 20515            

The Honorable Ami Bera, MD
1727 Longworth House Office Building
Washington, DC 20515 

Dear Representatives DelBene, Kelly, Marshall, and Bera: 
 
On behalf of the Medical Group Management Association (MGMA), I commend you for introducing the bipartisan ‘‘Improving Seniors’ Timely Access to Care Act of 2019.” Prior authorization continues to be one of the most onerous administrative processes faced by physician practices and we are very supportive of eliminating or streamlining this process. We strongly support this important legislation that seeks to significantly improve the process of prior authorization for medical services.

MGMA is the premier association for professionals who lead medical practices. Since 1926, through data, people, insights, and advocacy, MGMA empowers medical group practices to innovate and create meaningful change in healthcare. With a membership of more than 40,000 medical practice administrators, executives, and leaders, MGMA represents more than 12,500 organizations of all sizes, types, structures and specialties that deliver almost half of the healthcare in the United States. 

The utilization-management requirements deployed by Medicare Advantage (MA) plans act as cost-control processes that require providers to qualify for payment by obtaining approval before performing a service. This process is overused, costly, inefficient, opaque, and, most importantly, often responsible for delays in the delivery of care to Medicare beneficiaries. This current approach to prior authorization needs to be dramatically reshaped to ensure authorization requirements are clinically valid and implemented in a way that is transparent, timely, efficient, flexible and standardized.

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