Qualifying healthcare providers exempt from prior authorization under Burgess bill

U.S. Rep. Michael Burgess (R-TX) recently sponsored a bipartisan bill to reduce the unnecessary burdens caused by the widespread use of prior authorization, which is a requirement that a healthcare provider obtain pre-approval from Medicare to provide a given medical service.

Rep. Burgess on June 9 introduced the Gold Card Act of 2022, H.R. 7995, with original cosponsor U.S. Rep. Vicente Gonzalez (D-TX), which would exempt qualifying providers from prior authorization requirements under Medicare Advantage plans, according to the congressional record bill summary.

“Before coming to Congress, I practiced medicine for nearly 30 years and understand the frustration that comes from waiting on the government to tell me if I can provide certain treatments to my Medicare patients,” Rep. Burgess said. “I am grateful to fellow Texan, Congressman Vincente Gonzalez, for joining me in introducing this critical legislation that will allow patients to receive quality care in a timely manner by streamlining the prior authorization process for physicians.”

If enacted, H.R. 7995 would exempt providers from requiring prior authorization for a Medicare Advantage plan year if the provider had at least 90 percent of prior authorization requests approved the preceding year, according to a bill summary provided by Rep. Burgess’ staff.

Among several provisions, H.R. 7995 also would allow physicians to appeal Gold Card revocations they think were wrongly decided, the summary says, and would require the Secretary of the U.S. Department of Health and Human Services to issue a rule on the use of prior authorization by Medicare Advantage plans to ensure continuity of care for individuals transitioning to, or between, coverage to minimize disruption of ongoing treatments in previous plans.

“I have seen the support of this legislation in my home state and am confident that GOLD carding policy will be effective in improving clinical results,” said Rep. Burgess.

The American Association of Neurological Surgeons, the American Medical Association, and the Texas Hospital Association endorsed the bill, which has been referred to both the U.S. House Ways and Means Committee and the U.S. House Energy and Commerce Committee for consideration.

“I am proud to introduce the GOLD CARD Act with Dr. Burgess to remove barriers for patients to receive the care they deserve,” said Rep. Gonzalez. “No person’s care should be put on hold by bureaucratic red-tape. I urge our colleagues to support this critical legislation and ensure south Texans, and all Americans, receive top notch care.”