In late July 2022, the United States House of Representatives Ways and Means Committee marked up H.R. 8487, the Improving Seniors’ Timely Access to Care Act of 2022, unanimously voting to advance the legislation and positioning it for consideration by the entire Congress potentially this fall. The bipartisan legislation aims to “remove barriers to care by improving the efficiency and transparency of prior authorization” in Medicare Advantage (MA) plans.
According to a recent American Medical Association survey of physicians, 93% report that prior authorizations cause delays in patient care and 83% said that the process leads patients to abandon their treatment altogether.
The legislation would improve prior authorization by: establishing an electronic prior authorization program; standardizing and streamlining the prior authorization process for routinely approved services; reducing the amount of time a health plan is allowed to consider a prior authorization request; ensuring prior authorization requests are reviewed by qualified medical personnel; and increasing transparency around MA prior authorization requirements and their use.
Legislation is Supported by Many Representatives, Including Physicians
The legislation is shares relatively broad bipartisan support, with two Democrat and two Republican co-sponsors.
Talking about the fact that the legislation moved forward on a unanimous, bipartisan basis, Representative Adrian Smith said, “This kind of opportunity has become all too rare, and I hope that we can utilize this moving forward … to address the challenges that we are facing.” He continued noting that, “While prior authorization requirements have an important role to play in protecting our healthcare system from fraud and abuse, it has become clear that improvements are needed to ensure outdated technology or unnecessarily complicated paperwork does not stand in the way of seniors accessing needed healthcare … While this legislation may not be enough to address every concern with the prior authorization process, it’s a huge step toward a more modern, more efficient future.”
Several Representatives who are also healthcare providers have stated their support for the bill. “I ran for Congress because I saw people making healthcare decisions who had never seen a patient,” said Representative Brad Wenstrup, a podiatrist. “This bill will be revolutionary for patients and healthcare providers across the country.” Representative Greg Murphy, a urologic surgeon, also praised the legislation, saying, “The purpose of [prior] authorization was to try to keep too many tests from being ordered or try to prevent something that was ordered too much by some physicians, and I understand that. But the problem is, it has gotten so far out of control — it has hurt patients.”
Stakeholder Response
The Regulatory Relief Coalition applauds the move, saying “This committee’s action is a critical step toward fulfilling our coalition’s goal of ensuring that physicians spend more time treating patients and less time overcoming bureaucratic hurdles and barriers to care. With more than 300 House co-sponsors and over 500 endorsing organizations representing patients, providers, and the medical technology and biopharmaceutical industry, it is time for this bill to become the law of the land.”
The American Medical Association also supports the legislation, saying “The additional sections of the legislation mandating MA plans to issue faster prior authorization decisions are crucial policy improvements that will ensure more timely access to care and, as a result, improved patient health care outcomes and better stewardship of scarce Medicare resources…The AMA is proud to support the Improving Seniors’ Timely Access to Care Act. We commend the Ways and Means Committee for marking up this crucial bill and stand ready to work to ensure bipartisan passage by the House of Representatives.”