Prior Authorization Legislation Introduced in the Senate

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) late last month. The bill, called the Improving Seniors' Timely Access to Care Act of 2021 (S. 3018), was one of the priority issues discussed with congressional delegations during the 2021 Legislative Conference The ACC has been working with more than 400 state and national organizations, as well as key members of Congress, on the legislation for more than two years. The companion bill, H.R. 3173, was reintroduced in the House earlier this year. Specifically, the legislation would:

• Establish an electronic prior authorization process to streamline approvals and denials
• Establish national standards for clinical documents that would reduce administrative burdens on health care providers and MA plans
• Create a process for real-time decisions for certain items and services that are routinely approved
• Increase transparency between MA plans, health care providers and patients
• Ensure appropriate care by encouraging MA plans to adopt policies that adhere to evidence-based guidelines
• Require 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. 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."

Two Advocacy Priority Bills Under Review in House

Two priority pieces of legislation for ACC Advocacy continue to gain traction on Capitol Hill following the ACC's 2021 Legislative Conference and meetings with key lawmakers.

Both the Cardiovascular Advances in Research and Opportunities Legacy Act (CAROL Act) (H.R. 1193) and the Increasing Access to Quality Cardiac Rehabilitation Care Act of 2021 (H.R. 1956) were topics of discussion at an Oct. 20 House Energy and Commerce Committee public health hearing and subsequent conversations among the Committee continue.

The CAROL Act would authorize a grant program administered by the National Heart, Lung, and Blood Institute to support research on valvular heart disease (VHD) and encourage the use of technological imaging and precision medicine to generate data on individuals with VHD. In addition, the legislation would convene a workshop of subject matter experts to identify research needs and opportunities and instruct the Centers for Disease Control and Prevention to create education and public awareness programs regarding symptoms of VHD and effective strategies for preventing sudden cardiac death.

The cardiac rehabilitation (rehab) legislation would accelerate and expand the ability of physician assistants, nurse practitioners and clinical nurse specialists to supervise cardiac rehab programs under Medicare. Under the legislation, these practitioners would be able to administer programs in their offices, prepare and sign treatment plans and prescribe exercise. The bill would expedite the effective date of these changes to Jan. 1, 2022.

Stay tuned to the Advocate newsletter on Thursdays and @Cardiology on Twitter for ongoing updates.

Efforts Underway to Stop Medicare Cuts

Thanks in large part to efforts from ACC's Legislative Conference and other grassroots efforts, 247 members of Congress signed on to a letter led by Reps. Ami Bera, MD (CA) and Larry Buschon, MD (IN) urging House leadership to stop Medicare payment cuts slated for Jan. 1, 2022. The cuts, which are the result of an array of significant reductions due to a series of statutory and regulatory provisions, would exacerbate financial uncertainty and further threaten patient care at a time when cardiovascular clinicians are still on the frontlines of the COVID-19 pandemic. The ACC continues to be actively engaged in communicating with Congress to convey how detrimental these cuts will be to patient care. Look to the Advocate newsletter and @Cardiology on Twitter for additional opportunities to weigh in with members of Congress as discussions continue.