House committee advances bill that will reform Medicare Advantage prior auth

August 09, 2022

In late July, HR 8487—the Improving Seniors’ Timely Access to Care Act of 2022—passed out of the United States House of Representatives Ways and Means Committee with an overwhelming bipartisan vote. This legislation provides comprehensive reform of the Medicare Advantage prior authorization process by streamlining the health plan bureaucracy to help Medicare patients get the care they need – when they need it.

The bill now moves to the House Energy and Commerce Committee. The California Medical Association (CMA) strongly supports this bill and is working with the American Medical Association (AMA) and all of organized medicine to pass the bill before Congress adjourns in December.

Surveys of physicians have consistently found that excessive authorization controls required by health insurers are persistently responsible for serious harm when necessary medical care is delayed, denied or disrupted in an attempt to increase profits. In a 2021 AMA survey, 34% of physicians reported that prior authorization led to a serious adverse event for a patient in their care such as hospitalization, medical intervention to prevent permanent impairment, or even disability or death. Moreover, physicians and their staff spend nearly two days per week on prior authorizations creating costly administrative burdens.

HR 8487 would streamline Medicare Advantage prior authorization for routinely-approved services, ensure plans adhere to evidence-based guidelines developed by physicians, mandate public reporting of prior authorization decisions and timeframes, and implement an electronic process to reduce physician administrative burdens.

In California, CMA is also sponsoring SB 250 by Senator Richard Pan, M.D. SB 250 would require state regulators to streamline and reform the prior authorization system in a comprehensive way. The result will be less clinical time spent on administrative work, increased access to necessary care for patients and a restoration of the physician-patient relationship in medical decision making. 


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