Washington E-Newsletter

House Passes Prior Authorization Legislation

On Sept. 14, the U.S. House of Representatives unanimously passed by voice vote H.R. 3173, the Improving Seniors’ Timely Access to Care Act. Sponsored by Reps. Suzan DelBene (D-Wash.), Mike Kelly (R-Pa.), Ami Bera, MD, (D-Calif.) and Larry Bucshon, MD, (R-Ind.), the legislation would streamline and standardize prior authorization in the Medicare Advantage (MA) program. Among other things, the legislation:

  • Establishes an electronic prior authorization process;
  • Requires the U.S. Department of Health & Human Services to establish a process for real-time decisions for items and services that are routinely approved;
  • Improves transparency by requiring MA plans to report to the Centers for Medicare & Medicaid Services on the extent of their use of prior authorization and the rate of approvals or denials; and
  • Encourages plans to adopt prior authorization programs that adhere to evidence-based medical guidelines in consultation with physicians.

The American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) Washington Committee issued a press release applauding the passage of this legislation. Attention now turns to the U.S. Senate for its consideration. Sens. Roger Marshall, MD, (R-Kan.), Kyrsten Sinema (D-Ariz.), John Thune (R-S.Dak.) and Sherrod Brown (D-Ohio) have introduced a companion bill, S. 3018, with the same title.