• House Panel Advances Prior Authorization Relief Bill

    Bipartisan reform bill positioned for passage in Congress

    WASHINGTON, D.C. – The House Ways and Means Committee today voted unanimously to advance the Improving Seniors’ Timely Access to Care Act of 2022 (H.R. 8487), positioning the bill for passage in Congress possibly this fall. The bill would reform prior authorization under the Medicare Advantage program to help ensure America’s seniors get the care they need when they need it.

    Support for this commonsense legislation is overwhelming. The bill has more than 330 cosponsors in the House and Senate, and has been endorsed by more than 500 organizations, including the American Academy of Ophthalmology, and more than 30 additional ophthalmic subspecialty and state societies.

    recent report from the U.S. Department of Health and Human Services Office of Inspector General underscored the need for reform, finding that Medicare Advantage plans have denied prior authorization requests that met Medicare coverage rules.

    The bill was introduced by Reps. Suzan DelBene (D-WA), Mike Kelly (R-PA), Ami Bera, MD, (D-CA), and Larry Bucshon, MD, (R-IN). 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 improve prior authorization in MA plans by:

    • Establishing an electronic prior authorization (ePA) program;
    • Standardizing and streamlining the prior authorization process for routinely approved services, including establishing a list of services eligible for real-time prior authorization decisions;
    • Ensuring prior authorization requests are reviewed by qualified medical personnel; and
    • Increasing transparency around MA prior authorization requirements and their use.

    This bill has been years in the making. The Academy is a founding member of the Regulatory Relief Coalition, a group of sixteen national physician specialty and two allied organizations advocating for a reduction in Medicare program regulatory burdens to protect patients’ timely access to care and allow physicians to spend more time with their patients. We thank the bill’s sponsors, as well as the chair and ranking member of House Ways and Means Committee, Reps. Richie Neal (D-MA) and Kevin Brady (R-TX).

    “We believe this bill will help remove some of the unnecessary red tape that overburdens our healthcare system and prevents us from providing the care America’s seniors need when they need it,” said David Glasser, MD, the Academy's secretary for Federal Affairs. “We’re confident that when this bill comes to the House floor, Congress will agree with these commonsense reforms.”

     About the American Academy of Ophthalmology
    The American Academy of Ophthalmology is the world’s largest association of eye physicians and surgeons. A global community of 32,000 medical doctors, we protect sight and empower lives by setting the standards for ophthalmic education and advocating for our patients and the public. We innovate to advance our profession and to ensure the delivery of the highest-quality eye care. Our EyeSmart® program provides the public with the most trusted information about eye health. For more information, visit aao.org.