Prior Authorization Legislation Introduced in the Senate

On Dec. 17, Sens. Sherrod Brown (D-Ohio) and John Thune (R-S.D.) introduced S. 5044, the “Improving Seniors’ Timely Access to Care Act.” Building on similar legislation (H.R. 3107) introduced last year in the U.S. House of Representatives, this bill would reform the use of prior authorization in Medicare Advantage (MA) through a streamlined and standardized process that focuses on increased transparency and accountability. The bill reflects a neurosurgery-supported consensus statement on prior authorization, developed by leading national organizations representing physicians, hospitals and health plans.

Specifically, the legislation directs the Secretary of the U.S. Department of Health and Human Services to:

• Establish a real-time, electronic prior authorization process;
• Minimize the use of prior authorization for routinely approved services;
• Ensure prior authorization requests are reviewed by qualified medical personnel; and
• Require MA plans to report on their use of prior authorization, including delay and denial rates.

In the press release announcing the bill’s introduction, Senator Brown stated, “Older Americans shouldn’t be held up with unnecessary delays when seeking out medical treatment.” Senator Thune acknowledged that “Modernizing and streamlining the prior authorization process is important for seniors and providers.”

More information about the legislation is available from the Regulatory Relief Coalition, of which the AANS and the CNS are founding members.