What They Are Saying: Overwhelming Support For Rep. Kelly's Prior Authorization Reform Bill
WASHINGTON, D.C. -- In June, U.S. Representatives Mike Kelly (R-PA), Suzan DelBene (D-WA), Larry Bucshon, M.D. (R-IN) and Ami Bera, M.D. (D-CA) and U.S. Senators Roger Marshall, M.D. (R-KS), Kyrsten Sinema (I-AZ), John Thune (R-SD), Sherrod Brown (D-OH), introduced the Improving Seniors’ Timely Access to Care Act. The bipartisan, bicameral legislation streamlines the prior authorization process under Medicare Advantage (MA), allowing seniors to get the care they need while helping health care providers put patients over paperwork.
Since its introduction, the legislation has continued to gain support and is now backed by over 400 national and state organizations representing patients, physicians, MA plans, hospitals, and other key stakeholders in the health care industry.
See below to read what some organizations are saying about the Improving Seniors’ Timely Access to Care Act.
“We are honored to work with the Regulatory Relief Coalition (RRC), the lead organization comprised of national physician specialty organizations that are working with bill champions on this critically important legislation,” said Peggy Tighe, Principal at Powers Law. “RRC helped craft the legislation in 2018, moved it through committees and passage on the House floor in the last two Congresses, encouraged the Administration to finalize rules mirroring the legislation in January of this year, and is working in earnest to help Congress pass this bill this year. This bipartisan, bicameral, non-controversial, and widely supported legislation is one of the most widely supported health care bills in the 118th Congress.”
“Pennsylvania is one of the states with the largest penetration of Medicare Advantage plans and also has one of the largest populations in the nation of persons 65+ years of age. We know that delays in care can lead to significant health outcomes for older rural residents and exacerbate declines. The Pennsylvania Rural Health Association applauds the efforts to streamline the approval process for seniors enrolled in Medicare Advantage programs,” said Debra Youngfelt, President, Pennsylvania Rural Health Association.
“This legislation addresses one of the most common issues we hear about from our beneficiary network and ally groups. Prior authorization is an important tool in Medicare Advantage, and it is vital that we streamline this process for seniors,” said Mary Beth Donahue, President and CEO of Better Medicare Alliance. “We thank Senators Marshall, Sinema, Thune, and Brown, and Representatives DelBene, Kelly, Bera, and Bucshon for their leadership. With more than 33 million seniors now choosing Medicare Advantage, this work is more urgent and necessary than ever. We are pleased to join with hundreds of national organizations in support of this bill.”
“The Improving Seniors' Timely Access to Care Act takes critical action to address the denial of care by Medicare Advantage plans. Prior authorizations delay and prevent patients from receiving the timely care they need and deserve. This bipartisan legislation will improve access to care for Pennsylvania seniors by removing barriers that delay essential medical care and reducing burden on providers. HAP and Pennsylvania hospitals support and thank Representative Kelly for his leadership on this issue,” said Nicole Stallings, President and CEO of Hospital and Healthsystem Association of Pennsylvania (HAP).
“The current Medicare Advantage prior authorization process obstructs appropriate care for patients and is a drain on limited resources for facilities and providers,” said Alan Morgan, CEO, the National Rural Health Association. “This is especially true in rural facilities, where a shortage of staff means that time spent processing and negotiating prior authorizations is time that could otherwise be spent providing patient care. The National Rural Health Association is grateful to Senator Marshall for introducing legislation which will update, clarify, and add transparency to this process for the benefit of rural patients.”
“For those undergoing treatment for breast cancer, unnecessary delays caused by burdensome prior authorization requirements can be costly to both the patient and the health care system,” said Molly Guthrie, Susan G. Komen’s Vice President of Policy and Advocacy. “We proudly support the Improving Seniors’ Timely Access to Care Act and applaud the bill sponsors’ efforts to protect patients by setting necessary guardrails for prior authorization use in Medicare Advantage. We urge Congress to act swiftly to remove barriers to patients accessing the care they need when they need it.”
“We thank the sponsors for writing the bill so it will attract even more support. We came close last Congress to passing this much-needed reform. Our patients know all too well that prior authorization needs a dramatic overhaul. We think this is the year to get this bill over the finish line,” said Bruce A. Scott, M.D., President of the American Medical Association.
“As a physician, I know the importance of ensuring patients receive timely and appropriate care. Over the past few years, we have been working diligently to simplify and expedite the prior authorization process so providers can focus their time on patient care. Modernizing prior authorization in Medicare Advantage will benefit everyone, and we are proud to join insurers, providers, patients, caregivers, and advocates to support this important legislation,” said Dr. Ali Khan, Vice President and Medicare Chief Medical Officer, Aetna, CVS Health.
“The AHA greatly appreciates the leadership from this bipartisan group of Senators and Representatives to reintroduce vital legislation to streamline the broken prior authorization process in the Medicare Advantage program,” said Stacey Hughes, executive vice president at the American Hospital Association. “By removing unnecessary barriers that create delays in treatment, this meaningful bill will improve access to care for seniors and allow caregivers to spend more valuable time at the bedside with patients and less time on burdensome paperwork.”
“By reining in managed care plans’ unrestrained use of prior authorization, this legislation will both increase older adults’ access to much-needed care and ensure that providers can devote their attention to providing that care — rather than spending valuable time and energy emailing and uploading mounds of documentation to plans only to have requests denied. We applaud Senator Marshall (R-KS), Representative Kelly (R-PA) and the nearly 180 bipartisan cosponsors for taking on plans' overuse and abuse of prior authorizations and, by doing so, restoring accountability and transparency around prior authorization practices. Positive change is urgently needed; the Improving Seniors’ Timely Access to Care Act (S.4532 and HR 8702) will achieve it," said Katie Smith Sloan, President and CEO of LeadingAge.
“Humana is proud to continue to support the bipartisan, bicameral Improving Seniors’ Timely Access to Care Act, which will further modernize the prior authorization process and ensure that patients receive high-quality, safe and affordable care. We are encouraged that the bill promotes expediting approvals of care through greater adoption of electronic prior authorization (ePA), which has been demonstrated to improve health outcomes and reduce costs for patients. We thank Senators Marshall, Sinema, Thune, and Brown and Representatives Kelly, DelBene, Bera, and Bucshon – for their leadership on modernizing the prior authorization process which will benefit seniors, providers, and Medicare Advantage organizations,” said Dr. Kate Goodrich, Chief Medical Officer, Humana.
“The National Association for Home Care & Hospice wholeheartedly endorses the bipartisan, bicameral Improving Seniors’ Timely Access to Care Act,” said William Dombi, President and CEO of the National Association for Home Care & Hospice. “For too long, enrollees and providers of health care in patients’ homes have had to endure untimely, burdensome, unreliable, and oftentimes erroneous prior authorization processes. The Act will go a long way to rectifying these concerns and protecting seniors when they need essential health care. We call on Congress to pass this legislation now.”
"As President of the AMAC Action, I am proud to support the Improving Seniors' Timely Access to Care Act (S.4532 H.R. 4532),” said Bob Carlstrom, President and CEO of the Association of Mature American Citizens. “This crucial legislation will streamline the prior authorization process under Medicare Advantage, ensuring that our members receive the medical services they need without unnecessary delays. By removing bureaucratic obstacles, this act will significantly enhance the quality of care for millions of seniors, providing timely access to treatments and improving overall health outcomes. We commend the bipartisan effort behind this initiative and urge Congress to pass this important legislation for the well-being of our senior community.”
“The current prior authorization process creates frustrating administrative roadblocks for patients and providers. The bipartisan Improving Seniors’ Timely Access to Care Act, would promote electronic prior authorization and streamline access to care in the Medicare Advantage program. It is a breath of fresh air for everyone who has ever tried to navigate this complicated process,” said Hal Wolf, President & CEO of the Healthcare Information and Management Systems Society (HIMSS). “HIMSS looks forward to working with the Senate and House sponsors of this legislation to get this critical piece of administrative simplification signed into law. Our mutual goal is to reduce an unnecessary burden in healthcare that will benefit patients and health systems alike.”
"With more than 33 million Medicare Advantage beneficiaries nationwide, the Improving Seniors’ Timely Access to Care Act is a big win for patients and physicians alike,” said Joseph Alhadeff, MD, President of Physician-Led Healthcare for America. “Every day, in small towns and large cities, the prior authorization process not only prevents seniors from getting the care they need, but also buries physicians in a deluge of bureaucratic red tape. In fact, there's no bigger obstacle to the patient-physician relationship than prior authorization—which is tantamount to practicing medicine without a license. That's why we strongly support this legislation's reforms to prior authorization. By increasing transparency, establishing new electronic systems, and enabling CMS to enforce more timely decisions, it will help empower physicians to do what they do best: take care of their patients. What's more, the CBO projects that the share of all Medicare beneficiaries enrolled in Medicare Advantage will jump from 51% today to 62% by 2033. With this in mind, we applaud the Senate and House sponsors for taking such decisive action now. It's a much-needed fix to one of the most broken pieces of our healthcare delivery system."
"Free2Care is dedicated to advocating for timely and effective healthcare for all, including seniors, and we strongly support the bipartisan Improving Seniors' Timely Access to Care Act,” said Josephine Gallagher, Executive Director of Free2Care. “Delays in care due to cumbersome prior authorization processes under Medicare Advantage can have life-threatening and even fatal consequences. This critical legislation will modernize these processes, ensuring that seniors receive the medical services they need without unnecessary delays. The passage of this act is essential to safeguard the health and well-being of our elderly population. We urge legislators to act swiftly in support of this vital initiative."
“Thank you for improving timely access to care for those navigating difficult treatment decisions,” said Steve Hentzen, Co-Founder of the Prostate Network. “Our men need and deserve it.”
BACKGROUND
Prior authorization is a tool used by health plans to reduce unnecessary care by requiring health care providers to get pre-approval for medical services. But it’s not without fault. The current system often results in unconfirmed faxes of a patient’s medical information or phone calls by clinicians which takes precious time away from delivering quality and timely care. Prior authorization continues to be the #1 administrative burden identified by health care providers, and three out of four Medicare Advantage enrollees are subject to unnecessary delays due to prior authorization. In recent years, the Office of the Inspector General at the U.S. Department of Health and Human Services (HHS) raised concerns after an audit revealed that Medicare Advantage plans ultimately approved 75% of requests that were originally denied. More recently, HHS OIG released a report finding that MA plans incorrectly denied beneficiaries’ access to services even though they met Medicare coverage rules.
Health plans, health care providers, and patients agree that the prior authorization process must be improved to better serve patients and reduce unnecessary administrative burdens for clinicians. In fact, leading health care organizations released a consensus statement to address some of the most pressing concerns associated with prior authorization.
Specifically, the bill would:
- Establish an electronic prior authorization process for MA plans including a standardization for transactions and clinical attachments.
Increase transparency around MA prior authorization requirements and its use. - Clarify CMS’ authority to establish timeframes for e-PA requests including expedited determinations, real-time decisions for routinely approved items and services, and other PA requests.
- Expand beneficiary protections to improve enrollee experiences and outcomes.
Require HHS and other agencies to report to Congress on program integrity efforts and other ways to further improve the e-PA process. - Previously, Rep. Kelly led similar legislation in the 117th Congress. The Improving Seniors’ Timely Access to Care Act unanimously passed the House last Congress and was cosponsored by a majority of members in the Senate and House of Representatives.
Bill text is available here.
A section-by-section summary can be found here.
This bill is supported by over 370 national and state organizations representing patients, physicians, MA plans, hospitals, and other key stakeholders in the health care industry. To see the list as of today, click here.
You can learn more about the bill here.