Press Releases

DelBene, Kelly, Marshall and Bera Lead Bipartisan Legislation that Helps Medicare Patients by Reducing Prior Authorization Barriers

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Washington, D.C., June 5, 2019 | comments
Today, Reps. Suzan DelBene (D-WA), Mike Kelly (R-PA), Roger Marshall (R-KS), and Ami Bera (D-CA) introduced H.R. 3107, the Improving Seniors’ Timely Access to Care Act of 2019, which would improve delivery of care by streamlining and standardizing prior authorization in Medicare Advantage, while also providing much needed oversight and transparency of health insurance for America’s seniors. 

Prior authorization is a tool used by insurers to reduce spending through improper payments and unnecessary care by requiring physicians and other health care professionals to get pre-approval for medical services. However, it’s not without fault. Each plan has a unique way of handling prior authorization, often requiring the faxing of a patient’s medical information or phone calls by clinicians, which takes precious time away from patient care and can potentially lead to a delay of needed medical intervention. 

This bipartisan legislation would improve the prior authorization process in Medicare Advantage (MA) plans through common-sense transparency, electronic adoption, and an analysis on the items and services subject to prior authorization. Of all the much-needed updates to prior authorization, none is more critical than ensuring that, for routinely approved services, health plans make prior authorization available in “real time” so that physicians and their staff have more time to spend on patient care, rather than paperwork. In addition, the bill includes an important surgical exception that allows the surgeon to rely on the initial authorization if he/she needs to perform additional services while the patient is in surgery.  

“When seniors need critical medical care, doctors and support staff should be spending their time working with patients instead of having to haggle with insurance companies over whether they can do their jobs. This bipartisan legislation creates sensible rules for the road and will offer transparency and oversight to the prior authorization process. I’m pleased to work with Reps. Kelly, Marshall, and Bera on this vital legislation for our nation’s seniors,” said Rep. DelBene.

“We cannot allow seniors to be delayed or denied medically necessary care. This bill would streamline the process for routine non-complex medical services offered through Medicare Advantage. I am grateful to Reps. DelBene, Marshall, and Bera for working with me to bring physicians and insurers together to standardize prior authorization requirements, and for enhancing the ability of HHS to study and improve the Medicare Advantage program,” said Rep. Kelly.

“Prior to my time in office I served as the attending physician of a regional hospital in rural Kansas. My top priority has always been to provide quality care to my patients, and I have carried that charge with me into my service in the House,” Rep. Marshall, MD said. “I am proud to have worked alongside Reps. Suzan DelBene, Mike Kelly, and Ami Bera to streamline the prior authorization process within Medicare Advantage. This legislation would improve electronic transmissions, provide transparency for beneficiaries as well as providers, and increase CMS oversight on how prior authorization is used. This bipartisan bill demonstrates that Congress can work together to make the lives of patients and their families better.” 

“As a doctor, I’m proud to be cosponsoring this long-needed legislation to help relieve administrative burdens on practicing physicians,” said Rep. Ami Bera, MD. “Physicians spend far too much time on burdensome paperwork and seeking authorization on certain items, when they can be spending that time taking care of their patients. This bill modernizes the process, and is a win for physicians and patients.”

The bill has been endorsed by several leading health providers, patient advocacy groups, and other organizations including:

Regulatory Relief Coalition (including the American Academy of Neurology, American Academy of Ophthalmology, American Association of Neurological Surgeons, Congress of Neurological Surgeons American College of Cardiology, American College of Rheumatology, American College of Surgeons, and the American Urological Association), American Association of Orthopedic Surgeons, American Medical Association, American Physical Therapy Association, American Osteopathic Association, American Gastroenterological Association, American Society for Radiation Oncology, American Society of Clinical Oncology, Alliance for Specialty Medicine, American College of Physicians, Change Healthcare, American Society of Plastic Surgeons, American Society of Interventional Pain Physicians, Medical Group Management Association, California Medical Association.
 
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Tags: Health