ACC-supported legislation to reform the Medicare Advantage (MA) prior authorization process was introduced by Sens. Roger Marshall, MD (R-KS), Kyrsten Sinema (D-AZ), and John Thune (R-SD) on Oct. 20.

S. 3018, the Improving Seniors’ Timely Access to Care Act of 2021 is a bipartisan Senate companion to H.R. 3173, which was reintroduced in the House earlier this year. The legislation builds on two years of work by Congressional offices, as well as over 400 national and state organizations representing stakeholders within the health care field, including the ACC. Support for the legislation was a critical ask during the College’s recent 2021 Legislative Conference.

Highlights from the bill include:

• Establishing an electronic prior authorization process that would streamline approvals and denials
• Establishing national standards for clinical documents that would reduce administrative burdens health care providers and MA plans
• Creating a process for real-time decisions for certain items and services that are routinely approved
• Increasing transparency that would improve communication channels and utilization between MA plans, health care providers, and patients
• Ensuring appropriate care by encouraging MA plans to adopt policies that adhere to evidence-based guidelines
• Requiring beneficiary protections that would ensure the electronic prior authorization serves seniors first 

“Prior authorization is a significant barrier to patient access in today’s health care and the ACC has been committed to driving prior authorization reform to improve patient care and reduce administrative burden,” said ACC Health Affairs Committee Chair Samuel O. Jones IV, MD, MPH, FACC. “That’s why the ACC is proud to see the Senate introduction of the bipartisan legislation, ‘The Improving Seniors’ Timely Access to Care Act.’ It will help reduce administrative burdens that hinder optimal care and ensure our patients are not only getting the care they need, but also when they need it. We look forward to continuing to work with members of Congress to pass this needed legislation.”

Visit ACC's Prior Authorization Reform Hub here.

Clinical Topics: Cardiovascular Care Team

Keywords: ACC Advocacy, Prior Authorization, Medicare Part C, Physicians, Physician-Patient Relations, Preservation, Biological, Health Personnel, Electronics, Health Services Accessibility

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