AHA Letter of Support for the GOLD Card Act of 2023 (H.R. 4968

August 28, 2023

The Honorable Michael Burgess, M.D.
U.S. House of Representatives
2161 Rayburn House Office Building
Washington, DC 20515

The Honorable Vicente Gonzalez
U.S. House of Representatives
154 Cannon House Office Building
Washington, DC 20515

Dear Representatives Burgess and Gonzalez:

On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, our clinician partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups, the American Hospital Association (AHA) writes in support of the GOLD Card Act of 2023 (H.R. 4968), which would exempt qualifying providers from prior authorization requirements under Medicare Advantage (MA) plans.

While commercial insurers state that prior authorization is a tool to align health care services with a patient’s insurance coverage, the practice too often is used in a manner that leads to dangerous delays in treatment and contributes to waste in the health care system. Inefficient or misapplied prior authorization negatively impacts quality of care, interferes with timely patient access and contributes to clinician burnout.

To address these issues, the GOLD Card Act would exempt providers from requiring prior authorization for a MA plan year if the provider had at least 90% of prior authorization requests approved the preceding year. It also would limit reviews for a Gold Card to no more than once every 12 months, which allows providers to rely on the exemption for an established length of time. Additionally, your bill would increase continuity of care in MA plans by requiring the Health and Human Services Secretary to issue a rule on the use of prior authorization for individuals transitioning to or between coverage to minimize the disruption of ongoing treatments in previous plans.

America’s hospitals and health systems support gold carding programs, which substantially reduce administrative burdens and costs and streamline access to care for

Medicare beneficiaries. Gold carding programs help eliminate unnecessary delays in care by enabling providers who have demonstrated consistent adherence to evidence-based guidelines to be granted exemptions from prior authorization requirements.

Inappropriate delays in prior authorization are a pervasive problem among certain plans in the MA program. We appreciate your leadership and commitment to reducing some of these burdens and increasing timely access to care for seniors. We look forward to continuing to work with you on this important issue.

Sincerely,

/s/

Lisa Kidder Hrobsky
Senior Vice President, Advocacy and Political Affairs