House Passes Prior Authorization Relief Bill

The House voted overwhelmingly to reform prior authorization under the Medicare Advantage program to help ensure America’s seniors get the care they need when they need it. It’s a bill the American Academy of Ophthalmology helped craft to rein in an abusive insurance company practice. We urge the Senate to quickly advance the legislation to the Senate floor.

The overwhelmingly bipartisan bill had 323 cosponsors in the House, and support in the Senate has risen to 42 cosponsors. It has been endorsed by nearly 500 patient, provider, and other advocacy organizations.

“This bill is years in the making, and we are closer now than we’ve ever been to protecting our patients from unnecessary care delays and denials,” said Stephen D. McLeod, MD, CEO of the Academy. “We couldn’t have gotten this far without our congressional champions, including Reps. Suzan DelBene (D-WA), Mike Kelly (R-PA), Ami Bera, MD, (D-CA), and Larry Bucshon, MD, (R-IN). Now it’s up to the Senate to get it over the finish line.”

If enacted, the Improving Seniors’ Timely Access to Care Act of 2022 (H.R. 3173, as amended) would streamline and standardize prior authorization in the Medicare Advantage (MA) program, providing much-needed oversight and transparency. 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.

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.

This is also a big win for the Regulatory Relief Coalition, of which the Academy is a founding member. The Coalition includes 16 national physician specialty and 2 allied organizations that advocate 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. 

In remarks before the vote, Reps. DelBene and Kelly thanked the Regulatory Relief Coalition, “for helping to develop a quality bill and build support for it,” said DelBene.

Improving Seniors’ Timely Access to Care Act of 2022, Medicare Advantage, prior authorization

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