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  • Prior Authorization Relief Bill Reaches Significant Milestone

    Coalition Calls for Congressional Action in 2021

    WASHINGTON, DC — H.R. 3173, the Improving Seniors’ Timely Access to Care Act of 2021, reached a significant milestone with over one-half of the U.S. House of Representatives co-sponsoring this commonsense, bipartisan legislation, positioning the bill for swift passage in Congress.

    Introduced by Reps. Suzan DelBene (D-WA), Mike Kelly (R-PA), Ami Bera, MD, (D-CA), and Larry Bucshon, MD, (R-IN), the legislation 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. 

    H.R. 3173 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. More than 300 national and state patient, physician, health care professional and other health care stakeholder organizations have endorsed this legislation. 

    “The need to modernize prior authorization is now,” said John K. Ratliff, MD, a practicing neurosurgeon at Stanford University. “The burden of prior authorization has reached a critical stage as health plans continue to delay and deny medically necessary services to patients who have critical health care needs,” he added.

    “Our patients simply can’t wait when their vision is at stake,” said ophthalmologist George A. Williams, MD, Senior Secretary for Advocacy of the American Academy of Ophthalmology. “Improving Seniors’ Timely Access to Care Act is the right relief at the right time,” he said. “Our champions – Representatives DelBene, Kelly, Bera, and Bucshon – know the way forward and are taking us to a place where unnecessary barriers to necessary care will be a thing of the 

    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, American Society for Cardiovascular Angiography and Interventions.

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