August 02, 2023
Last week, the U.S. House of Representatives Ways and Means Committee advanced a bill that would reform 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 – the Heath Care Price Transparency Act of 2023 (H.R. 4822) – was amended to include the prior authorization reforms included in the Improving Seniors Timely Access to Care Act of 2022 (H.R. 3173) and passed with bipartisan support.
H.R. 3173 passed the U.S. House of Representatives unanimously in 2022 but did not advance through the Senate because of the high legislative cost of the bill. After the bill stalled, the Biden Administration stepped in and proposed two sets of regulations that, once finalized, would remove the legislative cost for the bill and allow Congress to ensure the reforms are protected in statute.
“This passage, along with the endorsements of more than 500 organizations, signals that modernizing and streamlining the prior authorization process for the nearly 32 million Americans who are currently enrolled in Medicare Advantage is long overdue," said California’s Ami Bera, M.D., and the other House champions of the H.R. 3173 reforms in a joint statement. "This would allow our nation’s seniors to receive the care they are entitled to faster. As we continue to work with federal agencies on implementing complementary efforts, we appreciate the Committee’s commitment to advancing our legislation. We look forward to continuing to work in a bipartisan manner with our House and Senate colleagues to advance these commonsense reforms."
The California Medical Association (CMA) strongly supports these reforms, which would increase transparency and improve the prior authorization process for patients and physicians.
CMA is also sponsoring a bill at the state level that would institute a one-year “gold card” exemption program from prior authorization requirements for physicians who have at least a 90% prior authorization approval rate. The bill – SB 598, authored by Senator Nancy Skinner – would also allow physicians to have appeals of their prior authorization denials reviewed by a licensed health professional of the same or similar specialty.
Share Your Story
You can help CMA advocate for prior authorization reforms by sharing your story with us. We want to hear from patients and physicians who have experienced delays in care because of the broken prior authorization process. Click here to add your voice to help reform the prior authorization process to ensure that patients receive the care they need — when they need it.