Ama Policy

Utilization Review, Medical Necessity Determination, Prior Authorization Decisions D-320.977

U.R. Criteria

1. Our AMA will advocate: (a) for implementation of a federal version of a prior authorization “gold card” law, which aims to curb onerous prior authorization practices by many state-regulated health insurers and health maintenance organizations; and (b) that health plans should offer physicians at least one physician-driven, clinically-based alternative to prior authorization, including a “gold-card” or “preferred provider program.”

2. Our AMA will request that the Council on Ethical and Judicial Affairs review current ethical opinions similar to the Texas Medical Association Board of Councilors’ opinions regarding medical necessity determination and utilization review.

Policy Timeline

Res. 727, A-22