Press Releases

DelBene, Kelly, Bera, Bucshon Introduce Bipartisan Legislation to Make Care More Efficient for Seniors by Reforming Prior Authorization

Today, Representatives Suzan DelBene (WA-01), Mike Kelly (PA-16), Ami Bera (CA-07), and Larry Bucshon (IN-08) introduced the Improving Seniors’ Timely Access to Care Act, bipartisan legislation that would improve care for seniors by streamlining and standardizing the way Medicare Advantage (MA) plans use prior authorization and increasing oversight and transparency around prior authorization.

Health insurers, including many MA plans, require providers to obtain prior authorization for certain medical treatments or tests before they can provide care to their patients. Prior authorization can play a role in ensuring people receive clinically appropriate treatments and help control the cost of care. However, when misused, prior authorization can result in administrative burdens for providers, taking precious time away from patient care and delaying needed medical intervention. In 2018, the U.S. Department of Health & Human Services’ (HHS) Office of the Inspector General raised concerns after an audit revealed that MA plans ultimately approved 75% of requests that were originally denied.

Health plans and providers agree that the prior authorization process can be improved and agreed on principles in a 2018 consensus statement. Building on these principles, the bill would:

  • Establish an electronic prior authorization process.
  • Require HHS to establish a process for “real-time decisions” for items and services that are routinely approved.
  • Improve transparency by requiring MA plans to report to Centers for Medicare & Medicaid Services (CMS) on the extent of their use of prior authorization and the rate of approvals or denials.
  • Encourage plans to adopt prior authorization programs that adhere to evidence-based medical guidelines in consultation with physicians.

“When seniors need critical medical care, doctors and other health care providers should be spending their time working with patients instead of going back and forth on requests that should be electronic, standardized, and eventually automated,” said DelBene. “The majority of the health care community agrees that prior authorization needs to be reformed. This bipartisan legislation creates sensible rules for the road and will offer transparency and oversight to the prior authorization process.”

“Americans who are enrolled in Medicare Advantage plans sometimes face unnecessary delays in treatment and diagnoses, but this legislation will modernize the process of prior authorization so medical providers can offer them safe, timely, and affordable care. This common sense, bipartisan plan will give seniors peace of mind and improve America’s health care system,” said Kelly. “Thank you to my colleagues for working with me on this vital bill that will make a real difference in the lives of Medicare Advantage enrollees.”

“As a doctor, I am proud to help introduce this long-needed legislation to help relieve administrative burdens on practicing physicians and prevent unnecessary delays in care for patients,” said Bera. “Physicians spend far too much time on burdensome paperwork and seeking authorization on certain items, when they should be spending that time taking care of their patients. This bipartisan bill modernizes the process, and is a win for physicians and patients.”

“Inefficiency within the prior authorization process creates unnecessary paperwork, lag time, and hassle for doctors that can delay life-saving procedures for Hoosiers,” said Bucshon. “I am proud to join my colleagues in introducing the bipartisan Improving Seniors’ Timely Access to Care Act which would increase transparency within the prior authorization process in Medicare Advantage. This bill eliminates red tape by streamlining and modernizing an outdated program for doctors, allowing them to quickly get their patients the care they need—putting patients over paperwork.”

In the 116th Congress, this bipartisan legislation was cosponsored by 280 members. It has also been endorsed by over 70 health provider and patient advocacy groups including:

ACCSES, Accuray, Inc., Alabama Society for the Rheumatic Diseases, Alliance for Aging Research, Alliance for Aging Research, Alliance for Patient Access, Alliance of Specialty Medicine, American Academy of Family Physicians, American Academy of Neurology, American Academy of Ophthalmology, American Academy of PAs, American Association of Clinical Urologists, American Association of Neurological Surgeons, American Association of Orthopaedic Surgeons, American Association on Health and Disability, American Clinical Laboratory Association, American College of Cardiology, American College of Gastroenterology, American College of Mohs Surgery, American College of Obstetricians and Gynecologists, American College of Osteopathic Surgeons, American College of Rheumatology, American College of Surgeons, American Medical Association, American Osteopathic Association, American Physical Therapy Association, American Society for Gastrointestinal Endoscopy, American Society for Radiation Oncology, American Society of Anesthesiologists, American Society of Retina Specialists, American Society of Transplant Surgeons, American Urogynecologic Society, Arkansas Orthopaedic Society, Arkansas Rheumatology Association, Association for Clinical Oncology, Association of Academic Physiatrists, Association of Freestanding Radiation Oncology Centers, Brain Injury Association of America, Bridge the Gap - SYNGAP Education and Research Foundation, California Medical Association, Cancer Support Community, Community Liver Alliance, Congress of Neurological Surgeons, Depression and Bipolar Support Alliance, Epilepsy Foundation, Federation of American Hospitals, Global Liver Institute, GO2 Foundation for Lung Cancer, Hospital and Healthsystem Association of Pennsylvania, International Essential Tremor Foundation, International Foundation for Autoimmune & Autoinflammatory Arthritis, KidneyCAN, Lakeshore Foundation, LeadingAge, Lupus and Allied Diseases Association, Medical Group Management Association, Medical Oncology Association of Southern California, Michael J. Fox Foundation for Parkinson's Research, MidWest Rheumatology Association, Multiple Sclerosis Association of America, National Association of Spine Specialists, National Association of State Head Injury Administrators, National Comprehensive Cancer Network, Pennsylvania Society of Oncology & Hematology, Premier, Prostate Network, RetireSafe, Society for Cardiovascular Angiography and Interventions, Society for Vascular Surgery, Society of Gynecologic Oncology, Susan G. Komen, Washington Rheumatology Alliance, and West Virginia Orthopaedic Society.

“Prior authorization remains a major obstacle to achieving optimal patient care,” said American Medical Association President Susan Bailey. “The time delays and administrative burdens continue to undermine health care outcomes. Most startlingly, 30 percent of physician respondents to a 2020 AMA survey reported that prior authorization led to a serious adverse event for a patient in their care such as hospitalization, medical intervention to prevent permanent impairment, or even disability or death. The AMA commends Reps. DelBene, Kelly, Bera, and Bucshon for introducing the Improving Seniors’ Timely Access to Care Act, legislation that would place placing patient needs first by simplifying and streamlining the prior authorization processes in Medicare Advantage.”

“As a group of national physician specialty organizations, the Regulatory Relief Coalition (RRC) is proud to advocate for regulatory burden reduction so physicians can spend more time taking care of patients. For many years, physicians and patients have been asking Congress to address the overuse and misuse of prior authorization in Medicare Advantage,” said Peggy Tighe, RRC’s Legislative Counsel. “RRC is proud to work closely with Reps. DelBene, Kelly, Bera, and Bucshon through bipartisan, bicameral efforts involving all stakeholders. Today, we celebrate these champions for their efforts to introduce the Improving Seniors’ Timely Access to Care Act. This common-sense legislation would bring much-needed oversight and transparency to the use of prior authorization for the betterment of the patients we serve.”

The full text of this bill can be found here.