Colorado Medical Society President Jan Kief, MD, testified yesterday before the Senate Health and Human Services Committee in support of Senate Bill 277 by Sen. Irene Aguilar, MD, Sen. President John Morse, and Rep. Joanne Ginal, which would standardize the prior authorization process for approval of drug benefit coverage. Some health plans and pharmacy benefit managers are working hard to kill the legislation. SB 277 is urgently needed to reduce administrative hassles and assure timely access to medically necessary medication.

SB 277:

• Requires the insurance commissioner to establish a workgroup and to adopt a new body of regulations that assures a transparent and uniform process:
• A two-page standardized form,
• A mandatory electronic version that prescribers may use to submit prior authorizations,
• A requirement that carriers and PBMs make prior authorization restrictions and requirements accessible in a centralized location on their website, including a list of drugs that require prior authorization, clinical criteria that are easily understandable, and the clinical criteria for reauthorization.
• Requires carriers and PBMs, when notifying the prescriber of its decision to approve a prior authorization, to include a unique prior authorization number attributable to this request, specification of the approved drug benefit, the date for review of the approved drug, the criteria that the prescriber will need to submit for re-approval, and a notice that the covered person has a right to appeal any adverse determination.

Dr. Kief told the committee that, if passed, the bill will inspire change through a collaborative process, provide patients with the medications they need in a more timely manner, and reduce the administrative complexity of the prior authorization process. Click here to read her full testimony.

The bill passed unanimously out of committee. However, it must still pass the House and the Senate and its fate is uncertain as the session winds down. We urge you to contact your senator and representative today to ask them to support this bill.

To find who represents you, click here to go to the "My Neighborhood" app. Expand the "Legislators" tab on the left and check the boxes for "State House of Representatives" and "State Senate." Enter your home address in the yellow box at the top left and select "Go." Follow the links in the results to your representative and senator's webpages for their contact information, including their e-mail address.

Congress is closer than ever before on a plan that would eliminate Medicare's sustainable growth rate formula and replace it with a new payment system. Additionally, the president included an SGR repeal in his 2014 budget and called for the development of "scalable accountable payment models to promote affordable quality care," AMA reports.

In an AMA statement, AMA President Jeremy Lazarus, MD, of Denver, said, "We are pleased that President Obama's 2014 budget recognizes the need to eliminate the broken Medicare physician payment formula known as the SGR and move toward new ways of delivering and paying for care that reward quality and reduce costs. The president's proposals align with many of the principles developed by the AMA and 110 other physician organizations on transitioning Medicare to include an array of accountable payment models."

Two key committees of the U.S. House of Representatives - Energy and Commerce, and Ways and Means - asked for comments on a draft framework that they plan to bring before the full House this summer. AMA wrote in a letter strongly recommending a phase-out approach to the SGR, starting with three to five years of stable, positive updates to give physicians time to transition to new payment models. This will pave the way for a successful Phase II, which would implement pay-for-performance-type programs based on quality.

The May 1 deadline - that would have required physicians who refer or order services for Medicare patients to be enrolled in the Medicare internet-based Provider Enrollment, Chain and Ownership System (PECOS) - has been delayed. The Centers for Medicare and Medicaid Services says this is due to technical issues. The Phase 2 ordering and referral denial edits "would have checked certain claims for an approved or validly opted-out physician or non-physician who is an eligible specialty type with a valid individual National Provider Identifier (NPI)."

CMS has not announced the new deadline, but physicians who have not done so already are encouraged to enroll in PECOS as soon as possible to avoid delays in processing. Click here for more information on this requirement.

Thomas Compton, chairman of the Colorado Oil and Gas Conservation Commission, has issued a letter in response to CMS' concerns about the commission's hydraulic fracture chemical disclosure rule, Rule 205A, and the Form 35 confidentiality agreement.

Within the last few months, CMS sought confirmation from COGCC that a physician has the right to access specific proprietary or confidential information - above what is available in the public domain - if it is necessary to care for a patient, and that physicians should be able to share the information with the patient and other physicians or providers involved in the patient's care without violating trade secret or confidentiality laws. CMS' action was in collaboration with Chris Urbina, MD, MPH, executive director and chief medical officer of the Colorado Department of Public Health and Environment; and Matthew Lepore, COGCC director.

COGCC assures CMS that "physicians are able to share information claimed to be a trade secret under Form 35 with patients, other health care professionals or health systems, and with public health agencies."

Further, "Commission Rule 205A requires oil and gas operators, vendors, and service providers to disclose the specific identity and amount of hydraulic fracturing chemicals claimed to be a trade secret to any health professional who requests the information, has a reasonable basis to believe that knowledge of the information will assist in diagnosis or treatment of a patient, and executes a Form 35 confidentiality agreement." The form obligates the physician to only use the information for medical diagnosis and other health needs.

Click here to read the full letter.

The abuse of prescription drugs is the fastest growing drug problem in the United States and a January 2013 survey found that Colorado has the second-highest rate of prescription drug abuse in the nation. Some diversion and abuse comes after family or friends pillage medicine cabinets for excess medications.

To reduce this risk and lessen the impact on the environment, the Colorado Department of Public Health and Environment encourages widespread participation in an upcoming event that allows the public to safely dispose of unused or expired household prescription drugs or over-the-counter medications. The next National Prescription Drug Take-Back Day will be held tomorrow, Saturday, April 27 10 a.m. - 2 p.m. Help in the cause by alerting your patients of this opportunity.

For more information, resources and to look up a collection site near you, go to www.DEA.gov or call 1-877-462-2911. Please note that the following items will not be accepted: needles and sharps, mercury (thermometers), oxygen containers, chemotherapy or radioactive substances, pressurized canisters, or illicit drugs.

Click here to download a flyer to post in your office. It's available in Spanish here.

Another installment from the American Medical Association's "Prescription for a Healthier Practice" series, the AMA recommends that physicians switch from paper billing to e-billing, particularly for workers' compensation and auto injury claims. AMA says e-billing can help improve the rate of first-time acceptance and your revenue cycle, and reduce the rate of resubmissions and the number of payer status calls.

To get started in automating these claims, AMA invites you to view the archived webinars, "Workers' compensation eBilling - A rapidly evolving solution to a historic revenue cycle headache!" and "How to Automate your Workers' Compensation Claims," which walk you through the process of adopting e-billing and provide tips to simplify the process.