The California Medical Association is urging physicians to contact their Members of Congress today and encourage them to sign a “Dear Colleague” letter that urges the Centers for Medicare and Medicaid Services (CMS) to promptly finalize its proposed prior authorization rules and hold big insurance companies accountable for the undue burden their policies put on physicians and patients. The deadline to sign is May 19, 2023. 

Last year, the U.S. House of Representatives passed the Improving Seniors' Access to Timely Care Act; bipartisan legislation with over 300 cosponsors requiring Medicare Advantage plans to adopt  standardized electronic prior authorization processes, make real-time decisions for routinely approved services, establish deadlines for responses, provide greater transparency related to the  use of clinically-appropriate utilization management guidelines, and provide rationales for denials.

Unfortunately, despite strong bipartisan support in the U.S. Senate, the bill failed to receive a floor vote leaving millions of patients without these prior authorization protections they so desperately need.

Thankfully, late last year CMS offered new proposed rules that, once finalized, would align with many of the key provisions of the Improving Seniors' Access to Timely Care Act and improve the prior authorization process for physicians and their patients.

Members of Congress in both the House and Senate are circulating a "Dear Colleague" letter urging CMS to promptly finalize the proposed rule and further expand its provisions to better align with the Improving Seniors' Timely Access to Care Act. In particular, the letter urges CMS to include a mechanism for plans to issue real-time prior authorization decisions for routinely approved services, establish a 24-hour deadline for plans to respond to emergent prior authorization decisions, and provide more detailed  metrics on the requests that are approved and denied and the timelines.

This flawed system must be fixed. This is where you come in – if you're sick and tired of the unnecessary burden that prior authorization imposes on both physicians and patients, please contact your Representative and Senators and urge them to sign on to this important Dear Colleague today.