On June 12, Sens. Roger Marshall, MD, (R-Kan.); Kyrsten Sinema (I-Ariz.); John Thune (R-S.D.) and Sherrod Brown (D-Ohio) and Reps. Mike Kelly (R-Pa.), Suzan DelBene (D-Wash.), Ami Bera, MD, (D-Calif.) and Larry Bucshon, MD, (R-Ind.) introduced the Improving Seniors’ Timely Access to Care Act (S.4532/H.R. 8702). This bipartisan bill would codify and enhance elements of the Advancing Interoperability and Improving Prior Authorization processes rule that was finalized by the Centers for Medicare & Medicaid Services (CMS) earlier this year. Specifically, the legislation would:
- Establish an electronic prior authorization (e-PA) process for Medicare Advantage (MA) plans;
- Increase transparency around MA prior authorization requirements and their use;
- Provide a pathway for CMS to institute real-time decisions for routinely approved medical services;
- Clarify CMS’ authority to establish timeframes for e-PA requests; and
- Require several reports to Congress on program integrity efforts and other ways to improve the e-PA process.
In announcing the introduction of the legislation, Sen. Marshall issued a press release featuring the Regulatory Relief Coalition’s (RRC) support. The AANS and the CNS issued a press release lauding the legislation. Subsequently, Becker’s Spine Review published an article quoting Russell R. Lonser, MD, FAANS, chair of the department of neurosurgery at The Ohio State University and chair of the AANS/CNS Washington Committee. Policy & Medicine also published an article on the topic, quoting Dr. Lonser, “The widespread overuse of prior authorization, especially in Medicare Advantage, has led to unacceptable delays and denials of essential medical treatments. We are optimistic that this will be the year Congress acts to safeguard timely care for our seniors.”
Katie O. Orrico, JD, AANS CEO was quoted in a MedPage Today article, “Health Groups Have High Hopes for the Latest Prior Authorization Bill.” The article states that medical groups are optimistic that the recently reintroduced bill to rein in prior authorization has a better chance of passage now than it did last time around. “We believe the bill is poised for adoption this year,” said Ms. Orrico.
The legislation is supported by nearly 450 national and state organizations representing patients, physicians, MA plans, hospitals and other key stakeholders in the health care industry. Support continues to grow.
