Press Releases

Representatives Suzan DelBene (WA-01), Mike Kelly (PA-16), Larry Bucshon, M.D. (IN-08) and Ami Bera, M.D. (CA-06) and Senators Roger Marshall, M.D. (KS), Kyrsten Sinema (AZ), John Thune (SD), and Sherrod Brown (OH) recently introduced an updated Improving Seniors’ Timely Access to Care Act. The bipartisan legislation would streamline Medicare Advantage’s prior authorization process to help get seniors the care they need and reduce the burden on health care providers.

Since its introduction, the legislation has continued to gain support and is now backed by over 400 national and state organizations representing patients, physicians, Medicare Advantage 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:

National

 “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, 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.”

“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.”  

“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.

“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.”

“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.”

“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, which has been demonstrated to improve health outcomes and reduce costs for patients.  We thank Representatives DelBene, Kelly, Bera, and Bucshon, and Senators Marshall, Sinema, Thune, and Brown – 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.”

“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.”

Washington State

“The Improving Seniors' Timely Access to Care Act is an important step to ensure Washington’s seniors are receiving timely access to needed care. Delays in the prior authorization process not only harm patients, but also add unnecessary and costly burden for providers. We are grateful for Congresswoman DelBene’s leadership in this bi-partisan legislation. Her efforts will remove barriers to essential medical care and reduce burden on providers,” said Cassie Sauer, President and CEO, Washington State Hospital Association.

“Reducing the negative impact of prior authorization processes on physicians and patients continues to be a top priority of the Washington State Medical Association. We are thankful for Representative DelBene for introducing the Improving Seniors’ Timely Access to Care Act so our patients can receive the care they need, when they need it,” said Dr. Arinola Dada, Overlake Arthritis and Osteoporosis Center and Washington State Medical Association Member.

“People with Medicare Advantage plans should not be inappropriately denied care through the prior authorization process. AARP supports the bipartisan Improving Seniors' Timely Access to Care Act to ensure everyone in Medicare - whether in Medicare Advantage or traditional Medicare - are treated fairly and get the health care they need when they need it most,” said Senior V.P. of Government Affairs Bill Sweeney.

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. However, the current system often results in multiple faxes or phone calls by clinicians which takes precious time away from delivering care. Prior authorization continues to be the number-one administrative burden identified by health care providers and nearly three out of four Medicare Advantage enrollees are subject to unnecessary delays due to the practice.

In recent years, the U.S. Department of Health and Human Services (HHS) revealed that Medicare Advantage plans ultimately approved 75% of requests that were originally denied. More recently, HHS released a report finding that Medicare Advantage plans incorrectly denied beneficiaries access to services even though they met Medicare coverage rules.

The bill would:

• Establish an electronic prior authorization process for Medicare Advantage plans including a standardization for transactions and clinical attachments.
• Increase transparency around Medicare Advantage prior authorization requirements and its use.
• Clarify HHS’ authority to establish timeframes for e-prior authorization requests including expedited determinations, real-time decisions for routinely approved items and services, and other prior authorization 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-prior authorization process.

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. In January, HHS finalized regulations that made many of the changes proposed in the legislation. The bill would codify these wins to ensure no future administration could undo them and make further improvements.

The bill text can be found here and a section-by-section can be found here.