ACC-Supported Prior Authorization Reform Legislation Reintroduced in Congress

The Improving Seniors' Timely Access to Care Act of 2021, legislation that will reform the prior authorization process within Medicare Advantage, was reintroduced by Reps. Suzan DelBene (D-WA), Mike Kelly (R-PA), Ami Bera, MD (D-CA) and Larry Bucshon, MD (R-IN) on May 13. The ACC has strongly supported this legislation and has been instrumental in building support throughout the legislative process.

Specifically, the legislation would:

  • Establish an electronic prior authorization process and require Medicare Advantage (MA) plans to adopt electronic prior authorization (e-PA) capabilities;
  • Require the U.S. Secretary of Health and Human Services to establish a list of items and services eligible for real-time decisions under an MA e-PA program;
  • Standardize and streamline the prior authorization process for routinely approved items and services;
  • Ensure prior authorization requests are reviewed by qualified medical personnel;
  • Increase transparency around MA prior authorization requirements and their use; and
  • Protect beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans.

"Prior authorization is imposed on physicians to obtain pre-approval for medical test and treatments … This process is time-consuming, burdensome, and of no clinical benefit to the patient. In fact, the time spent on prior authorization takes an average of two days each week by physicians and their staff – this is time that would be better spent taking care of patients. These hurdles not uncommonly lead to delays in medical care for patients. In order to help preserve the patient-physician relationship and in order to streamline care, we are excited about the transparency and oversight that will be brought to the Medicare Advantage program by the Improving Seniors' Timely Access to Care Act of 2021, and look forward to working with Congress and other parties to make the system better for our cardiovascular patients," said ACC Health Affairs Committee Chair Samuel O. Jones IV, MD, MPH, FACC.

The ACC, as part of the Regulatory Relief Coalition, is excited to continue efforts supporting this legislation, which has been a major Advocacy priority for the College and was included as part of ACC's 2020 Legislative Conference priorities. ACC members can take action by contacting their Member of Congress and asking for their support and co-sponsorship here. 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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