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- AMA Amends Model Prior Authorization Legislation Per CAP’s Request on ‘Gold Card’ Practice
The American Medical Association (AMA)’s Council on Legislation approved the CAP’s amendment to the AMA’s model prior authorization legislation. The CAP worked with AMA staff to advocate for a payment safeguard containing a prior authorization “gold card” to void any adverse financial impacts to pathologists and physicians involved in the rendering of a service.
The CAP asked the AMA to include an enhanced payment safeguard to extend protection to pathologists and clinical laboratories involved in the rendering of a health care service. The CAP encourages health insurance carriers not to limit or deny payment to a physician or laboratory that provides a service based on whether the ordering physician has utilized or failed to utilize a laboratory benefit management program.
In 2021, Texas enacted the first gold carding law in the nation with a payment safeguard to protect qualified providers from denials or reductions in payment when granted a prior authorization requirement.
The CAP has been actively monitoring states pursuing prior authorization gold-cards, which exempt qualified providers from prior authorization requirements who demonstrate a high degree of performance and adherence to evidence-based medicine. This year, the CAP advocated on this issue in Colorado and California and will continue to partner with state pathology societies and state medical associations to ensure adequate protection to payment for services that are subject to any gold-card waiver.
The CAP’s amendment will protect pathologists and clinical laboratories from unnecessary payment denials and reductions as states look to advance the model legislation.