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  • Help Build Support as Prior Authorization Reform Bill Moves to Senate

    We are encouraged by the unanimous vote of approval for the Improving Seniors’ Timely Access to Care Act in the House of Representatives last week.

    Building on this important step, we still have work to do to move this prior authorization reform legislation to the president’s desk.

    Last week the Congressional Budget Office released a report that estimated the bill would significantly raise Medicare costs by billions of dollars over 10 years, due to greater use of services. All of the bill’s lead sponsors have disputed the CBO score. Rep. Larry Bucshon, R-Ind., specifically raised challenged the score during the Energy and Commerce committee markup before the House vote.

    An April report from the Department of Health and Human Services Office of Inspector General found Medicare Advantage plans denied prior authorization approvals for services that should have been covered. In light of that report, Rep. Bucshon said the Congressional Budget Office concerns about increased utilization was flawed.

    Its “task is to score legislation based on current law, not on the current state of affairs where entities are failing to follow the law,” he said.

    “This bill simply increases the timeliness of patient care. It does not add to the list of services [Medicare Advantage] plans are required to cover. It does not change the [Medicare Advantage] appeals process. It does not require additional payments by [Medicare Advantage] plans. Therefore, a score based on current law should not reflect a change in utilization if plans were following the law,” he said.

    House and Senate leadership, along with our Congressional champions, held an emergency meeting with the Congressional Budget Office today to work to resolve this issue.

    At the time of House passage, the legislation to streamline and standardize prior authorization in the Medicare Advantage program had 326 co-sponsors. That represents nearly three-quarters of the entire House of Representatives. The Senate version of the bill has bipartisan support of nearly half of the chamber with 43 co-sponsors.

    A lead sponsor of the Senate bill, Sen. Roger Marshall, R-Kan., has said, “This is the most-supported health care bill in the entire Congress both in the number of co-sponsors and the weight of more than 500 national and state endorsing organizations. The support underscores our legislation’s significance to patients, health care providers and innovators in medicine.”

    Even with such broad bipartisan, bicameral support, we still need you to contact your senators and let them know how this legislation will improve Medicare Advantage for patients and providers.

    Your voice is essential, given the packed Senate schedule between now and the end of the year. With midterm elections just weeks away, any Senate action on this bill won’t come until the lame-duck session between election day and the end of the year. You can take this time to build more support for this in the Senate.