Prior Authorizations Should Not Stand Between Seniors And Their Health Care

News from Representative Kelly

October 8, 2021

Legislation to Streamline Care and Reform Health Insurance for Seniors Reaches Bipartisan House Majority

WASHINGTON, DC - Today, Representatives Mike Kelly (PA-16), Suzan DelBene (WA-01), Larry Bucshon (IN-08), and Ami Bera (CA-07) secured the support of a bipartisan majority for the Improving Seniors' Timely Access to Care Act (H.R. 3173) with 227 cosponsors in the U.S. House of Representatives. The legislation would improve care for seniors by streamlining and standardizing the way Medicare Advantage (MA) plans use prior authorization and increasing oversight and transparency.

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 patients receive clinically appropriate treatments and help control the cost of care. However, when overused, prior authorization can result in administrative burdens for providers, taking precious time away from patient care and delaying needed medical intervention.

"Health care needs to be simple, accessible, and timely for our seniors. Too often, seniors are left waiting while bureaucratic prior authorizations are being processed," said Kelly. "While prior authorizations can serve an important role, they should not stand as a barrier to care. By modernizing the prior authorization process for Medicare Advantage, we can ensure doctors are able to focus on their patients rather than on paperwork. I'm proud to be a champion of this legislation, and am grateful to my 218+ colleagues for their support."

"Paperwork should never get in the way of seniors accessing timely, critical care. Prior authorization is an important tool, but we need to bring it into the 21st century so that our seniors get the medical attention they need when they need it," said DelBene. "I am pleased that we secured the support of 227 cosponsors, and counting, for commonsense legislation that will reform prior authorization and establish transparency and oversight throughout its process. Physicians and nurses have struggled immensely to meet the demands of the pandemic and are suffering from burnout at rates not seen before. The Seniors' Timely Access to Care Act would make every provider's day easier when it's fully implemented."

"As a practicing physician I routinely dealt with burdensome processes that slowed patient care and chained doctors, nurses, and other healthcare workers to their desk instead of preforming life-saving procedures," said Bucshon. "This year, I was proud to join my colleagues in introducing the bipartisan Improving Seniors' Timely Access to Care Act to increase transparency and streamline the prior authorization process in Medicare Advantage. Now with more than 218 cosponsors, I look forward to working with my colleagues to get this bill passed the House and later signed into law providing real relief for healthcare workers across the field."

"As a doctor, I am proud to help lead this long-needed legislation to 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. The bipartisan Improving Seniors' Timely Access to Care Act modernizes the process and is a win for physicians and patients."

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.