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  • Coalition Applauds Senate for Introduction of Prior Auth. Reform Legislation

    Coalition Calls for Congressional Action in 2021

    WASHINGTON, DC — The Regulatory Relief Coalition (RRC) is thrilled to support legislation introduced this week in the Senate, S. 3018, that mirrors H.R. 3173, the Improving Seniors’ Timely Access to Care Act of 2021. Original sponsors of the Senate bill include Senators Roger Marshall, MD (R-KS), Kyrsten Sinema (D-AZ), and John Thune (R-SD).

    S. 3018/H.R. 3173 would help protect America’s seniors 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 Medicare beneficiaries. The legislation would require electronic prior authorization, improve transparency for beneficiaries and providers alike, and increase Centers for Medicare & Medicaid Services (CMS) oversight on how Medicare Advantage (MA) plans use prior authorization. 

    Endorsed by more than 300 national and state patient, physician, health care professional and other health care stakeholder organizations, the House companion legislation reached a significant milestone with over one-half of the U.S. House of Representatives co-sponsoring the legislation earlier this month. The House legislation is led by Reps. Suzan DelBene (D-WA), Mike Kelly (R-PA), Ami Bera, MD, (D-CA), and Larry Bucshon, MD, (R-IN).

    “We are ready for action,” said John K. Ratliff, MD, a practicing neurosurgeon at Stanford University. “With the Senate joining the House in this bipartisan, commonsense legislation, Congress is well positioned to act now to ensure that patients receive access to medically necessary services,” he added. “We enthusiastically applaud the Senators who are advancing this legislation,” said ophthalmologist George A. Williams, MD, Senior Secretary for Advocacy of the American Academy of Ophthalmology. “On the heels of the House bill gaining 218 co-sponsors, the Senate’s action is an excellent sign that Congress can act now to protect patients,” he added. 

    Based on a consensus statement on prior authorization reform adopted by leading national organizations representing physicians, medical groups, hospitals, pharmacists, and health plans, the Improving Seniors’ Timely Access to Care Act of 2021 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.
    • Protect beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans.
    The Regulatory Relief Coalition (RRC) is a group of fifteen national physician specialty and two allied organizations advocating for a reduction in Medicare program regulatory burdens to protect patients’ timely access to care, allowing physicians to spend more time with their patients.

    RRC Members: American Academy of Family Physicians, the American Academy of Neurology, American Academy of Ophthalmology, American Academy of Orthopedic Surgeons, American Association of Neurological Surgeons, College of Cardiology, American College of Rheumatology, American College of Surgeons, American Gastroenterological Association, American Osteopathic Association, Association for Clinical Oncology, Congress of Neurological Surgeons, Medical Group Management Association, National Association of Spine Specialists, Society for Cardiovascular Angiography and Interventions.

    RRC Allies: Premier, Inc. and American Medical Rehabilitation Providers Association