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Your PM&R Delegates Advocate for Prior Authorization in the House of Medicine

Members & Publications

March 30, 2022

The House of Delegates is the principal policy-making body of the American Medical Association. Your Academy is actively involved in the AMA House of Delegates efforts through our PM&R delegates and the PM&R Section Council. The Council serves as a representative for physical medicine and rehabilitation physicians, advocating for policies that affect physiatrists and their practices.

Over the past several meetings, your PM&R delegates have successfully advocated that the American Medical Association (AMA) House of Delegates (HOD) enact AMA policy to make various improvements to the prior authorization process, including:

  • Asking the Centers for Medicare and Medicaid Services to further regulate Medicare Advantage Plans so that the same treatment and authorization guidelines are followed for both fee-for-service Medicare and Medicare Advantage patients, including admission to inpatient rehabilitation facilities.
  • Advocating that proprietary criteria shall not supersede the professional judgment of the patient’s physician when determining Medicare and Medicare Advantage patient eligibility for procedures and admissions.

Advocating that all insurance companies and benefit managers that require prior authorization have staff available to process approvals 24 hours a day, every day of the year, including holidays and weekends.

For more information about physiatry’s role in the HOD, click here. 

Legislation Introduced to Alleviate Impact of Conversion Factor Cut for 2021

Nov 09, 2020

Last month, two bills were introduced in the House proposing solutions to the estimated 10.6% Physician Fee Schedule conversion factor cut expected to go into effect January 1, 2021.  The bills offer some relief to the cut, but do not reflect a comprehensive or long-term solution.  AAPM&R has therefore chosen to remain neutral regarding these bills. 

Your Academy continues to advocate for a permanent solution to the conversion factor cut while maintaining the important payment increases to office and outpatient evaluation and management services.

 

 

 

 

 

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