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  • Washington Highlights

    AAMC-Backed Prior Authorization Reform Bill Passes House Committee


    Siddharth Nagisetty, Health Policy and Advocacy Intern
    Allyson Perleoni, Director, Government Relations
    For Media Inquiries

    The House Ways and Means Committee marked up and passed by voice vote the AAMC-supported Improving Seniors’ Timely Access to Care Act of 2022 (H.R. 8487) on July 27. The legislation would add requirements that would better regulate the use of prior authorization in Medicare Advantage plans.

    Committee Chair Richard Neal (D-Mass.) opened the markup by recognizing the importance of “modernizing transactions and moving away from paper, faxes, and manual review of decisions,” noting that these reforms stand to cut costs and lessen provider burden. “Reducing burden, improving access to care, and increasing administration efficiencies are all commonsense reforms that I’m pleased this Committee can get behind on a bipartisan basis,” he stated.

    Ranking Member Kevin Brady (R-Texas) shared similar sentiments and encouraged passage of the bill stating, “For too long, both seniors and their doctors have been bogged down by unnecessary delays caused by prior authorization requirements. Seniors shouldn’t have to wait as their insurance seeks to pre-approve some treatments and services through telephone and fax, despite the abundance of faster electronic method.

    This AAMC-supported legislation would make it easier for beneficiaries in Medicare Advantage plans to receive care in an efficient manner by making three key changes. This bill would move Medicare Advantage plans away from paper and fax prior authorization reviews in favor of an electronic prior authorization program that would streamline processes and save time for both providers and patients. In addition, this program would need to adhere to specified standards while supplying real-time decisions on normally approved tests and services. The bill would also require Medicare Advantage plans to annually collect and publish information on their use of prior authorization and report that data to the Centers for Medicare & Medicaid Services (CMS). Finally, the bill would require Medicare Advantage programs to meet other baseline standards of efficiency and quality that would be set by the CMS.

    The legislation may still be considered by the Energy and Commerce Committee, which also has jurisdiction, or the full House of Representatives in the near future. A companion bill (S. 3018) has also been introduced in the Senate.