Congress to again consider prior authorization reform legislation

A “must-pass” bill that could improve the prior authorization process will get a new round of consideration in Congress.

A group of bipartisan lawmakers, including some congressional physicians, have reintroduced the Improving Seniors’ Timely Access to Care Act. The legislation that would reform Medicare Advantage has wide support but has stalled in recent years due to concerns about potential costs.

“Prior authorization is the number one administrative burden facing physicians today across all specialties,” Sen. Roger “Doc” Marshall, MD (R-Kansas), said in a news release. “As a physician, I understand the frustration this arbitrary process is causing health care practices across the country and the headaches it creates for our nurses.

“With the bipartisan, bicameral, Improving Seniors’ Timely Access to Care Act, we will streamline prior authorization and help improve patient outcomes and access to quality care and life-saving medicine,” Marshall said. “With the improvements we’ve made there is no reason we should not quickly get this bill signed into law.”

The bill has a mass of legislative supporters – at least 41 senators and 127 representatives, along with more than 370 organizations representing patients, physicians, hospitals and Medicare Advantage (MA) plans.

Marshall’s office offered a summary about what the latest legislation would do:

• Establish an electronic prior authorization (e-PA) process for MA plans including a standardization for transactions and clinical attachments.
• Increase transparency around MA prior authorization requirements and its use.
• Clarify the U.S. Centers for Medicare & Medicaid Services' authority to establish timeframes for e-PA requests including expedited determinations, real-time decisions for routinely approved items and services, and other PA requests.
• Expand beneficiary protections to improve enrollee experiences and outcomes.
• Require the US Department of Health and Human Services and other agencies to report to Congress on program integrity efforts and other ways to further improve the e-PA process.

The June 12 announcement included supportive statements from doctors Rep. Larry Bucshon, MD (R-Indiana), and Rep. Ami Bera, MD (D-California).

“An inefficient prior authorization process creates unnecessary paperwork, lag time, and hassle for doctors which can delay critical or life-saving procedures for patients,” said Rep. Larry Bucshon, MD (R-Indiana). “As a physician, I believe the best approach to solving challenges with our health care system is to put the patient first. That’s why I’m proud to join my colleagues in reintroducing the bipartisan Improving Seniors’ Timely Access to Care Act to promote transparency and electronic prior authorization in the Medicare Advantage program. Seniors are counting on us to ensure that they can receive the care they need when they need it.”

Bucshon was a career heart surgeon before serving in Congress, and Bera, an internal medicine specialist, served as chief medical officer of Sacramento County, California.

“I am pleased to introduce this bipartisan, bicameral legislation that will codify protections to help seniors access the medical care they are entitled to without unnecessary delays and denials due to prior authorization," Bera said. “Having practiced in medicine, it is crucial we create an environment where physicians can spend less time with an antiquated prior authorization system and spend more time taking care of their patients.”