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  • House Unanimously Passes Prior Authorization Bill That Academy Helped Craft

    The Academy and its Regulatory Relief Coalition have led the charge on finding a legislative fix to health plan prior authorization issues, and on Wednesday the House of Representatives voted to advance legislation we helped craft to the Senate.

    The Improving Seniors’ Timely Access to Care Act passed by voice vote.

    The bill would streamline and standardize prior authorization in the Medicare Advantage program, providing much-needed oversight and transparency while protecting beneficiaries from unnecessary care delays and denials.

    The legislation would require Medicare Advantage plans to:

    • Establish an electronic prior authorization program to streamline approval process
    • Standardize and streamline the prior authorization process for routinely approved services, including establishing a list of services eligible for real-time prior authorization decisions
    • Ensure prior authorization requests are reviewed by qualified medical personnel
    • Increase transparency around Medicare Advantage prior authorization requirements and their use

    During debate on the House floor lead sponsor Rep. Mike Kelly, R-Pa., said, “I’m really proud of this bill. It took a lot of time to get there, and it’s taken so many people to get there on both sides of the aisle, looking at the bill and saying this is something that just makes sense.”  

    He also told the story of an ophthalmology practice in his district, where a patient couldn’t get both eyes authorized for an operation, “because the system rejected the second eye as a duplicate.”

    In her remarks Rep. Suzan DelBene, D-Wash. thanked the Regulatory Relief Coalition “for helping to develop a quality bill and build support for it.”

    The Academy would like to thank our congressional champions, Reps. DelBene, Kelly, Ami Bera, MD, D-Calif., and Larry Bucshon, MD, R-Ind., and acknowledge the advocacy efforts of ophthalmologists everywhere. This important fix to prior authorization is one step closer to becoming law.

    The Senate version of the bill currently has 43 co-sponsors, but we are continuing to work with the lead sponsors, Sens. Roger Marshall, MD, R-Kan., Kyrsten Sinema, D-Ariz., John Thune, R-S.D., and Sherrod Brown, D-Ohio, to get it through the upper chamber by the end of the year.

    There is still time to contact your senator. Use our advocacy tool to let them know what this bill would mean for your practice and your patients.