• Key House Committee Advances Academy-Backed Bill to Reform Prior Authorization


    A top legislative priority for the Academy cleared a key formal step on Wednesday when the House Committee on Ways and Means voted unanimously to advance a bill to reform prior authorization in Medicare Advantage plans.

    With the committee’s action, the bill is one step closer to consideration by the full House of Representatives. If passed by the full House, the bill will then move to the Senate. The Academy and its Regulatory Relief Coalition will be pressing for additional action when the Congress returns from its summer recess break in September.

    If enacted, the Improving Seniors’ Timely Access to Care Act would streamline and standardize prior authorization in the Medicare Advantage (MA) 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
    • 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 the committee markup Rep. Suzan DelBene, D-Wash., the lead sponsor of the bill and stalwart ally of ophthalmology, referenced a recent report that found “prior authorization was responsible for delaying necessary care,” and stressed that the Improving Seniors’ Timely Access to Care Act would make “common sense changes to prior authorization.”

    “No more phone calls, no more faxes, no more wondering what paperwork is needed,” DelBene said.

    She also thanked the 500-plus health care organizations that supported the bill, in particular the Regulatory Relief Coalition, co-founded by the Academy, which she said “helped develop a quality product.”

    Key Backers of the Bill

    The Academy thanks DelBene for championing this bill and helping it garner over 300 co-sponsors. We also want to commend Ways and Means Committee Chair Richard Neal, D-Mass., and ranking member Kevin Brady, R-Texas, for their leadership advancing the Improving Seniors’ Timely Access to Care Act through their committee.

    The Academy applauds the other bill sponsors, Reps. Mike Kelly, R-Pa., Ami Bera, MD, D-Calif., and Larry Bucshon, MD, R-Ind., for their leadership and strong support on this important issue. We also appreciate that the Senate bill leads — Sens. Roger Marshall, MD, R-Kan., Kyrsten Sinema, D-Ariz., John Thune, R-S.D. and Sherrod Brown, D-Ohio, are working hard to build strong support for this legislation in the Senate where it has the support of more than 35 senators. The Academy will be working closely with our bill champions to secure the enactment of the legislation by the end of the year.

    Reps. Bera and Bucshon and Sen. Marshall are physicians, and DelBene noted that “their experience as physicians has been invaluable throughout this process”.

    The Academy’s OPHTHPAC® has been instrumental in backing physicians who run for Congress. You can help ensure ophthalmology has more champions at the federal level with an investment to OPHTHPAC or OPTHPAC Direct.