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Today, the House Ways & Means Committee marked up the Improving Seniors’ Timely Access to Care Act of 2022, legislation that would make it easier for seniors to get the care they need and improve health outcomes. The bill would modernize the antiquated prior authorization process in Medicare Advantage, which often still requires faxing documents to insurance companies.

The committee advanced the legislation by voice vote, teeing it up for a floor vote in the fall. The legislation is led by Representatives Suzan DelBene (WA-01), Mike Kelly (PA-16), Ami Bera, M.D. (CA-07), and Larry Bucshon, M.D. (IN-08). The original legislation has over 300 cosponsors, or 70 percent of the House, and the endorsement of over 500 organizations.

“It is 2022 and even Congress has moved beyond the fax machine. The health care system is complicated in the best of times. Doctors and their patients shouldn’t have to call or fax back and forth with insurance companies or send documents multiple times for procedures that are approved over 95 percent of the time,” said DelBene. “Our legislation that the Ways & Means Committee advanced today will make it easier for seniors to get the care they need. I want to thank the other leads on this legislation for what is a truly bipartisan success story along with Chairman Neal and Ranking Member Brady for their leadership.”

“When seniors go to the doctor, the focus should be on their health, not bureaucratic paperwork. That’s why I’m proud to be leading the bipartisan Improving Seniors’ Timely Access to Care Act, so seniors can focus on the things that really matter,” said Kelly. “This legislation moves the health care sector into the 21st century by giving doctors and Medicare Advantage plans the tools to make health coverage decisions in real-time. I want to thank my colleagues, Reps. DelBene, Bucshon, and Bera, as well as the Regulatory Relief Coalition for their tireless work on this issue.”

“As the former Chief Medical Officer for Sacramento County, I know that 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,” said Dr. Bera. “The bipartisan Improving Seniors’ Timely Access to Care Act will modernize and streamline the prior authorization process, allowing our nation’s physicians to provide the best care possible for their patients. I am proud that this long-needed legislation is one step closer to becoming law.”

“Prior authorization requirements can interfere with a doctor’s ability to provide quality access to care by creating unnecessary paperwork, increasing lag time, and adding hassle that can delay lifesaving procedures for Hoosiers. I am glad that my bipartisan Improving Seniors’ Timely Access to Care Act is one step closer to being signed into law and one step closer to helping patients,” said Dr. Bucshon. 

Many Medicare Advantage plans require providers to obtain prior authorization for certain medical procedures and tests before they can provide care to their patients. Prior authorization can play a role in ensuring people receive appropriate treatments and help control the cost of care. However, when misused, prior authorization can delay needed medical intervention and result in administrative burdens for providers.

The bill would:

• Establish an electronic prior authorization process.
• Require the U.S. Department of Health & Human Services (HHS) to establish a process for “real-time decisions” for items and services that are routinely approved.
• Improve transparency by requiring Medicare Advantage plans to report to the Centers for Medicare & Medicaid Services 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.

Earlier this year, HHS released a report illustrating the abuse of prior authorization in Medicare Advantage. It mirrored a similar report from 2019.

The video from the markup can be found here.