Washington E-Newsletter

Prior Authorization Bill Clears Critical Legislative Hurdle in Congress

On July 27, the U.S. House of Representatives Ways and Means Committee unanimously approved the Improving Seniors’ Timely Access to Care Act, as amended (H.R. 8487), legislation that 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 (HHS) 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 (CMS) 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.

In advance of the committee’s consideration, the Regulatory Relief Coalition (RRC) — which the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) co-lead — sent a letter supporting the amended bill and urging committee members to vote in favor of the legislation. Rep. Suzan DelBene (D-Wash.) singled out the coalition in her statement about the bill. In addition, after the vote, the AANS and the CNS issued a press release, as did the RRC, resulting in a Becker’s Spine Review article titled, “Neurosurgeons urge Congress to pass bill addressing prior authorization by year’s end,” quoting John K. Ratliff, MD, FAANS, chair of the AANS/CNS Washington Committee. The piece notes that the legislation would protect Medicare Advantage patients from prior authorization practices that could limit their timely access to medically necessary care.

Click here to watch the committee markup, here to read the AANS/CNS press release and here to read the RRC press release.