On June 21, 2023, Representatives Suzan DelBene (WA-01), Mike Kelly (PA-16), Ami Bera, M.D. (CA-06), and Larry Bucshon, M.D. (IN-08), and Senators John Thune (SD), Sherrod Brown (OH), Roger Marshall, M.D. (KS), and Kyrsten Sinema (AZ) called on the Centers for Medicare & Medicaid Services (CMS) to quickly finalize a set of proposed rules that would deliver quality care to seniors on Medicare faster by modernizing and streamlining prior authorization processes.
In letters signed by 233 members of the House and 61 senators, the lawmakers also call on Medicare officials to enhance the proposals to include real-time electronic decision-making for routinely approved services, require faster responses on emergency procedures from 72 to 24 hours, and include greater transparency requirements. This would bring the rules more in line with the lawmakers’ Improving Seniors’ Timely Access to Care Act.
“We urge CMS to promptly finalize and implement these changes to increase transparency and improve the prior authorization process for patients, providers, and health plans,” wrote the lawmakers. “We are pleased that these proposed rules align with the bipartisan, bicameral Improving Seniors’ Timely Access to Care Act, which proposes a balanced approach to prior authorization in the [Medicare Advantage] program that would remove barriers to patients’ timely access to care and allow providers to spend more time treating patients and less time on paperwork.”
Nationally, 28 million seniors are enrolled in Medicare Advantage.
The Improving Seniors’ Timely Access to Care Act unanimously passed the House last Congress. It was cosponsored by a majority of members of the House of Representatives and the Senate and was endorsed by over 500 leading health care organizations.
According to an American Medical Association physician survey, prior authorization has negatively impacted the health outcomes of patients 90 percent of the time, and 1 in 3 physicians report that prior authorization delays have led to a serious adverse health event, such as hospitalization or even death.
Last year, the U.S. Department of Health & Human Services Inspector General issued a scathing report that detailed how Medicare Advantage plans routinely denied care to seniors that they were entitled to receive under Medicare rules and required unnecessary documentation to delay or deny care.
A copy of the letter can be found here.
Original source can be found here.
