GOLD CARD Act of 2023 Getting Over Lengthy Delays in Care As Required by Doctors Act of 2023
The implications of HB 4968 are significant for healthcare providers and patients alike. By minimizing the bureaucratic burden on physicians in the Medicare Advantage sector, the bill seeks to enhance healthcare delivery efficiency, ultimately benefiting patients through quicker access to necessary treatments and services. The bill also mandates that the Secretary of Health and Human Services must monitor and report any impacts on communities at high risk for health disparities, ensuring that those populations continue to receive care without significant interruptions from regulatory challenges.
House Bill 4968, also known as the 'Gold Card Act of 2023,' aims to amend Title XVIII of the Social Security Act by exempting qualifying physicians from prior authorization requirements under Medicare Advantage (MA) plans. Introduced to streamline the care process for patients while reducing delays attributed to the prior authorization process, the bill establishes specific criteria for physicians to qualify for exemptions. Eligible physicians must have at least 90% of their prior authorization requests approved in the previous year to retain their exemption status for subsequent plan years.
While the bill is designed with the intent to expedite patient care, it has generated debate regarding its potential impact on the quality of care provided. Critics may argue that easing prior authorization requirements could lead to an increase in unnecessary procedures, thereby driving up healthcare costs. Additionally, there are concerns about whether the standards set for physicians qualifying for the exemption are sufficiently rigorous to prevent misuse of the exemption. This tension between improving efficiency and maintaining oversight in the healthcare system represents a critical point of contention surrounding HB 4968.