The AMA has asked the department to make employer plans follow the Medicare plans' example in a statement sent earlier this fall to the ERISA Advisory Council.

Employers' self-insured benefit plans operate under the jurisdiction of the U.S. Labor Department, rather than state regulators, thanks to a provision in the federal Employee Retirement Income Security Act of 1974.

The ERISA Advisory Council is an arm of the Labor Department's Employee Benefits Security Administration. The council helps EBSA and the Labor Department regulate ERISA plans.

The AMA told the council that ERISA plans' efforts to manage use of care through prior authorization programs and related programs are about as burdensome and demoralizing for physicians as the prior authorization efforts at Medicare Advantage plans are.

Regulators have made progress at adding tougher rules for Medicare Advantage plans, but "little reform progress impacted employer-sponsored plans regulated by the Department of Labor," the AMA says.

The Centers for Medicare and Medicaid Services, the agency that oversees Medicare Advantage plans, recently adopted a batch of prior authorization rules for 2024 and later years. One, for example, discourages the plans from conducting repeated reviews for patients who are continuing to get care for the same condition.

The AMA is asking the ERISA Advisory Council, EBSA and the Labor Department to set that kind of requirement for ERISA plans.

Today, CMS requires Medicare Advantage plans to review prior authorization requests within seven days and urgent requests within 72 hours.

EBSA and the Labor Department simply require employers' self-insured health plans to respond to prior authorization requests "within a reasonable time frame."

The AMA wants the Labor Department to build on the CMS requirements and take them a step further, by imposing a 24-hour response time limit on employer plans for urgent prior authorization requests and a 48-hour limit for non-urgent requests.