Rep. Suzan DelBene (D-WA) News Release

Today, Congresswoman Suzan DelBene (WA-01) hosted a roundtable discussion with Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure, Washington patients, and physicians to discuss the policy changes taking place that will improve Washingtonians access to health services and reduce burden on Washington providers.

During the discussion, participants highlighted their experiences with the health insurance companies' practice known as 'prior authorization,' which frequently involves numerous phone calls and paperwork exchanges between insurers, patients, and health care providers. This burdensome process often leads to delays in treatment, patients giving up on getting the care they're entitled to, and denials of necessary procedures that lead to worse and sometimes devastating health outcomes. It also adds a significant administrative burden to medical provider offices which is a major contributor to physician burnout and the challenges our state is facing to protect our health care workforce.

Prior authorization impacts 740,000 Washington seniors who are enrolled in Medicare Advantage plans, as well as millions of Americans covered by private and employer-sponsored health insurance.

"Today's discussion underscores the pressing need for us to bring this outdated practice into the 21st century so that seniors can get the care they deserve when they need it," said DelBene. "The Biden Administration's recent regulations were a great step forward, but we must go further and make these gains permanent. I will continue pushing Congress to pass my bipartisan legislation that would deliver better care for our seniors and ease unnecessary burdens for physicians and hospitals."

"CMS is dedicated to removing barriers in the health system so that people have timely access to the care they need," said CMS Administrator Chiquita Brooks-LaSure. "We applaud Congresswoman DelBene's efforts to build upon what CMS is doing to streamline prior authorization so that doctors and nurses can spend more time taking care of their patients instead of focusing on red tape."

Washingtonians joined the discussion to share their personal stories, including:

* David Baker, a Medicare Advantage patient from Kenmore, had to wait in pain while his insurance processed his prior authorization for knee surgery following a fall.

* Rick Timmins, a Medicare Advantage patient from Whidbey Island, had to wait several weeks to be approved for a cancer screening for a lump that was ultimately positive, delaying his treatment for the disease.

* Robin Sparks, a patient from Marysville, had her chemotherapy delayed for multiple months while she underwent treatment for lymphoma.

* Kathi Nash, a Medicare Advantage patient from Leavenworth, had her rehabilitative care cut off after two weeks following a total hip reconstruction when she was fully bed-bound.

In January, HHS issued new regulations aimed at curbing abuses in prior authorization that closely mirrors bipartisan legislation that DelBene has introduced for years.

DelBene recently reintroduced legislation that would codify those policies and provide CMS with additional tools to reign in health insurance plan abuses and improve care.

Read this original document at: https://delbene.house.gov/news/documentsingle.aspx?DocumentID=3883