Medical Association Endorses Prior Authorization Bill Reintroduced in Congress

Medical Association Endorses Prior Authorization Bill Reintroduced in Congress

On June 12, bipartisan lawmakers introduced an updated version of the Improving Seniors’ Timely Access to Care Act in both the House (H.R. 8702) and Senate (S. 4532). The Medical Association is supporting the latest version of this legislation that was introduced, once again, by Senators Roger Marshall, MD (R-KS), Krysten Sinema (I-AZ), John Thune (R-SD), and Sherrod Brown (D-OH), as well as Representatives Mike Kelly (R-PA), Suzan DelBene (D-WA), Ami Bera, MD (D-CA) and Larry Bucshon, MD (R-IN). 

In the 117th Congress (2021-2022), the Improving Seniors’ Timely Access to Care Act garnered more than 378 total bipartisan cosponsors in the House and Senate and also passed the full House of Representatives. In addition, the legislation secured endorsements from more than 500 outside organizations, including the Medical Association of the State of Alabama and numerous other national and state medical societies.  

Unfortunately, the version of this bill that passed the House in the 117th Congress was never considered in the Senate because it produced a score of $16 billion from the Congressional Budget Office (CBO), thus necessitating modifications to lessen the bill’s fiscal imprint. While electronic prior authorization rules that the Biden administration finalized in Jan. 2024 lowered the $16 billion score substantially, the recently introduced bill is amended to ensure it ultimately scores as close to $0 as possible.  

More specifically, the legislation requires the Office of National Coordinator for Health Information Technology (ONCHIT) and the Centers for Medicare & Medicaid Services (CMS) to submit a report to Congress on the use of prior authorization in Medicare Advantage and what constitutes “real-time decisions” for “routinely approved services.” The legislation also delegates explicit authority to CMS to implement this newly defined real-time prior authorization decision-making process for routinely approved services in Medicare Advantage. Finally, the legislation delegates explicit authority to the secretary of Health and Human Services to enforce the real-time prior authorization processes for routinely approved services and issue tighter timelines for health plans to make utilization management decisions, such as 24 hours for emergent services.  

Of note, the legislation is unchanged as it relates to: 

·         Mandating compliance with uniform electronic prior authorization technical standards 

·         Barring Medicare Advantage plans from utilizing faxes or proprietary payer portals 

·         Including robust transparency requirements (e.g., disclosure of policies and evidence utilized in formulating prior authorization, listing of all services subjected to prior authorization, how many services are denied and overturned on appeal, etc.) 

·         Permitting insurers to create gold-carding programs 

Click here for the Endorsement List.

Posted in: Advocacy, Medicaid, Medicare

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