Streamlining Prior Authorization Practices

The ACC supports the following list of prior authorization (PA) principles developed by an American Medical Association-led coalition that are centered around transparency, standardization and efficiency:

• Define "selective application of PA" to mean review and authorization for coverage of a test or treatment where appropriate for requests not covered by published clinical guidance.
• Prohibit procedure and medication substituting by payers consistent with Appropriate Use Criteria and guidelines.
• Allow for "prior authorization program review and volume adjustment," so payers and contracted benefit managers can authorize requests for tests and treatments from providers or practices that demonstrate compliance with established published clinical guidance.
• Require payers to make rates of allowed and denied procedures available to consumers.
• Avoid interruption in care by allowing patients granted coverage for a given treatment or medication under one payer to transfer that coverage to another payer.
• Establish online standardized PA tools and criteria for providers and their practice staff.

Co-sponsor and support the bipartisan Getting Over Lengthy Delays in Care As Required by Doctors (GOLD Card) Act (H.R. 4968), introduced by Reps. Michael Burgess, MD, (R-TX) and Vicente Gonzalez (D-TX), to exempt qualifying clinicians from PA requirements under Medicare Advantage plans.

Expanding Patient Access to CV Care

The ACC has long supported expanding access to cardiovascular and pulmonary rehabilitation services. Cardiac rehabilitation is a medically supervised program that includes exercise training, education on heart healthy living and counseling. For patients with cardiovascular disease, these programs are proven to reduce the risk of a future cardiac event, reduce all-cause mortality by 25%, decrease hospitalizations and the use of medical resources, and improve health-related quality of life. Expanding the cardiac care team's ability to order these services expands access to care for the patients who need it, particularly those who reside in rural and underserved areas.

Co-sponsor and support the Increasing Access to Quality Cardiac Rehabilitation Act of 2023 (H.R. 2583), introduced by Reps. Lisa Blunt Rochester (D-DE) and Adrian Smith (R-NE), which would expand the ability of the cardiac care team (PAs, NPs, CNSs) to order cardiac and pulmonary rehabilitation services beginning in 2024.

Increase Community Access to AEDs

Through legislation like the Access to AEDs Act, Congress can reduce sudden cardiac arrest among young athletes and their communities. The inability of a school to purchase or maintain an AED should not be a barrier to the availability of this lifesaving tool. This legislation also ensures that schools will adhere to best practices by requiring any heart health screening programs for student athletes to be consistent with ACC and American Heart Association guidelines.

Co-sponsor and support the Access to AEDs Act of 2023 (H.R. 2370/S. 1024), introduced by Reps. Sheila Cherfilus-McCormick (D-FL) and Bill Posey (R-FL) in the U.S. House and Sens. Cory Booker (D-NJ) and Richard Blumenthal (D-CT) in the U.S. Senate.

Reduce Unnecessary Amputations

Amputation can result in additional health concerns, reduced quality of life and in some cases, life-threatening conditions. Many peripheral artery disease-related amputations could be avoided through early diagnosis and attention to the condition, allowing clinicians to pursue aggressive risk factor modification, supervised exercise programs and surveillance studies. The ACC played a key role in helping to craft the Amputation Reduction and Compassion (ARC) Act by responding to requests for information, participating in briefings and taking part in the press conference celebrating the bill's introduction. This legislation marks a step forward in efforts to reduce health disparities and achieve health equity for patients in need of cardiovascular care.

Co-sponsor and support the ARC Act (H.R. 4261), introduced by Reps. Donald Payne (D-NJ), Jeff Van Drew (R-NJ), Ruben Gallego (D-AZ) and Chris Smith (R-NJ).

Strengthening Medicare For Patients and Clinicians

Significant reductions in physician payment for Medicare services and lack of inflationary updates exacerbate financial uncertainty for medical practices and threaten patient access to care. The ACC urges Congress to work with the College and the broader medical community to create sustainable and long-term solutions to the system and ensure clinicians can focus on providing high-quality patient care. Providing annual updates tied to inflation is a crucial step in creating a more stable system for both clinicians and patients.

Co-sponsor and support the Strengthening Medicare for Patients and Providers Act (H.R. 2474), introduced by Reps. Larry Bucshon, MD, (R-IN) and Raul Ruiz, MD, (D-CA). Click here to send your message.