RRC supports The Improving Seniors’ Timely Access to Care Act of 2021, a bill that would…
- Establish an electronic prior authorization (ePA) program and require MA plans to adopt ePA capabilities;
- Require the Secretary of Health and Human Services to establish a list of items and services eligible for real-time decisions under an MA ePA program;
- Standardize and streamline the prior authorization process for routinely approved items and services;
- Ensure prior authorization requests are reviewed by qualified medical personnel;
- Increase transparency around MA prior authorization requirements and their use; and
- Protect beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans.
The legislation is championed by Representatives Suzan DelBene (D-WA), Mike Kelly (R-PA), Ami Bera, MD (D-CA), and Larry Bucshon (R-IN) and Senators Roger Marshall, MD (KS), Krysten Sinema (D-AZ), and John Thune (R-SD). This bipartisan, bicameral legislation would help protect patients from unnecessary delays in care by streamlining and standardizing prior authorization under the Medicare Advantage program, providing much-needed oversight and transparency of health insurance for America’s seniors. Read the “Dear Colleague” letter sent on May 6th from the bill’s champions encouraging other Members to co-sponsor the bill. In early January 2022, the Regulatory Relief Coalition sent letters to the Committees on Ways and Means, Energy and Commerce, and Finance urging action.
Based on a consensus statement on prior authorization reform adopted by leading national organizations representing physicians, medical groups, hospitals, pharmacists, and health plans, the legislation would facilitate electronic prior authorization, improve transparency for beneficiaries and providers alike, and increase Centers for Medicare & Medicaid Services (CMS) oversight on how Medicare Advantage plans use prior authorization. Over 100 members of Congress called for such reform in a bipartisan letter to CMS in 2018. The letter was led by Representatives David P. Roe (R-TN) and Ami Bera (D-CA).